Risk factors for fatality in amniotic fluid embolism: a systematic review and analysis of a data pool

Abstract

Purpose: Investigating risk factors for amniotic fluid embolism (AFE)-induced fatality.

Methods: A systematic review of cases of AFE available on PubMed, Scielo, Scopus and AJOL databases that occurred from 1990 to 2015 was carried out. After careful reading of titles, abstracts and full texts, case reports of AFE were reviewed. Risk factors for AFE were considered as independent variables in logistic regression models. The first model was built on the whole data pool. The second model was built on typical cases of AFE, according to the classical triad of symptoms (heart, lungs, coagulopathy). The dependent variable was fatality in both models.

Results: 177 cases of AFE were assessed in the first model, while 121 typical cases of AFE were assessed in the second model. Among typical cases of AFE, only oxytocin infusion during labour increases the likelihood of death (odds ratio 2.890, 95% confidence interval 1.166–7.164, p = 0.022). No risk factors for fatality were found in the whole data pool.

Conclusions: Further research on national registries should focus on the behaviour of oxytocin infusion during labour in AFE cases.

Keywords:

• Amniotic fluid embolism
• oxytocin infusion
• labour induction
• outcome
• pregnancy complications
• delivery

Acknowledgements

We are grateful to Dr Aguilera L.G. (Servicio de Anestesiología y Reanimación, Hospital del Mar-Esperança. IMAS, Hospital Clínic, Barcelona, Spain), Dr Dabrowski M. (Klinika Kardiologii, Instytutu Kardiologii, Szpital Bielanski, Zespol Badawczo-Leczniczy Chorob Ukladu Krazenia ICMDiK PAN, Warsaw, Poland), Dr Bouman E.A. (Maastricht Universitair Medisch Centrum, Anesthesiology and Pain Medicine, Maastricht, Netherlands), Dr van Dorp W. (Erasmus MC, Department of Obstetrics and Gynaecology, Rotterdam, Netherlands), Dr Baghirzada L. (Department of Anaesthesia, University of Calgary, Calgary, Canada), Prof Gerli S. and Prof Di Renzo G.C. (Dipartimento di Ostetricia e Ginecologia – Azienda Ospedaliera di Perugia, Università di Perugia, Perugia, Italy), Dr Bøgeskov R. (Anæstesiologisk Afdeling, Herlev Hospital, Denmark), Dr Ben Ismail M. (Service de gynécologie obstétrique, centre hospitalier François Quesnay, Mantes-la-Jolie cedex, France) who assisted us in finding some articles. We thank Prof Indraccolo E. (Dipartimento di Scienze Economiche e Statistiche, Università di Salerno, Salerno, Italy) who freely translated from German and Mrs Dobrowolska A. (Unità Operativa Complessa di Ematologia e Medicina Interna, Ospedale di Civitanova Marche, Area Vasta 3 – Marche, Civitanova Marche (MC), Italy) who freely translated from Polish. We finally thank the Editorial Office of the Clinical and Experimental Obstetrics & Gynecology, 7847050 Canada Inc., who gave permission of reproducing Figure 1.

Disclosure statement

The authors report no conflict of interest.