Advertisement

Incidence and risk factors of amniotic fluid embolisms: a population-based study on 3 million births in the United States

Published:February 25, 2008DOI:https://doi.org/10.1016/j.ajog.2007.11.061

      Objective

      Amniotic fluid embolism (AFE) is a condition occurring during delivery that can lead to severe maternal morbidity and mortality. Given the rarity of its occurrence, current estimates and predictors of the incidence and outcomes are often difficult to obtain.

      Study Design

      We conducted a population-based cohort study on 3 million birth records in the Healthcare Cost and Utilization Project–Nationwide Inpatient Sample from 1999 to 2003 to estimate the incidence and case fatality of AFEs. Logistic regression was used to calculate the odds ratio (OR) and corresponding 95% confidence intervals (CIs) of demographic and obstetrical determinants of AFEs and fatal AFEs.

      Results

      The overall incidence of AFE was 7.7 per 100,000 births (95% CI 6.7 to 8.7), with a case fatality rate of 21.6% (95% CI 15.5 to 27.6%). AFE was associated with maternal age greater than 35 (OR 2.2, 95% CI 1.5 to 2.1), placenta previa (OR 30.4, 95% CI 15.4 to 60.1), and cesarean delivery (OR 5.7, 95% CI 3.7 to 8.7). Although AFEs were not significantly associated with induction of labor (OR 1.5, 95% CI 0.9 to 2.3), they were associated with preeclampsia, abruptio placentae, and the use of forceps. Among women with an AFE, common demographic or obstetrical determinants were not predictive of maternal mortality.

      Conclusion

      AFE is a rare but serious condition that is associated with advanced maternal age, placental pathologies, and cesarean deliveries. Further research on the treatment of this condition is necessary.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Clark S.L.
        • Hankins G.D.
        • Dudley D.A.
        • Dildy G.A.
        • Porter T.F.
        Amniotic fluid embolism: analysis of the national registry [see comment].
        Am J Obstet Gynecol. 1995; 172 (discussion 1167-9): 1158-1167
        • Fava S.
        • Galizia A.C.
        Amniotic fluid embolism.
        Br J Obstet Gynaecol. 1993; 100: 1049-1050
        • Gilbert W.M.
        • Danielsen B.
        Amniotic fluid embolism: Decreased mortality in a population-based study.
        Obstet Gynecol. 1999; 93: 973-977
        • Kramer M.S.
        • Rouleau J.
        • Baskett T.F.
        • Joseph K.S.
        Maternal Health Study Group of the Canadian Perinatal Surveillance.
        Lancet. 2006; 368: 1444-1448
        • O'Shea A.
        • Eappen S.
        Amniotic fluid embolism.
        Int Anesthesiol Clin. 2007; 45: 17-28
        • Tuffnell D.J.
        United kingdom amniotic fluid embolism register.
        BJOG. 2005; 112: 1625-1629
        • Judich A.
        • Kuriansky J.
        • Engelberg I.
        • Haik J.
        • Shabtai M.
        • Czerniak A.
        Amniotic fluid embolism following blunt abdominal trauma in pregnancy.
        Injury. 1998; 29: 475-477
        • Schoening A.M.
        Amniotic fluid embolism: historical perspectives and new possibilities.
        MCN Am J Matern Child Nurs. 2006; 31: 78-83
        • Tramoni G.
        • Valentin S.
        • Robert M.O.
        • et al.
        Amniotic fluid embolism during caesarean section.
        Int J Obstet Anesth. 2004; 13 ([see comment]): 271-274
        • Petersen M.L.
        • Sinisi S.E.
        • van der Laan M.J.
        Estimation of direct causal effects.
        Epidemiology. 2006; 17: 276-284
        • Price T.M.
        • Baker V.V.
        • Cefalo R.C.
        Amniotic fluid embolism.
        Obstetr Gynecol Surv. 1985; 40: 462-475
        • Robillard J.
        • Gauvin F.
        • Molinaro G.
        • Leduc L.
        • Adam A.
        • Rivard G.E.
        The syndrome of amniotic fluid embolism: A potential contribution of bradykinin.
        Am J Obstet Gynecol. 2005; 193: 1508-1512
        • Lorence D.P.
        • Ibrahim I.A.
        Benchmarking variation in coding accuracy across the United States.
        J Health Care Finance. 2003; 29: 29-42
        • Webbink D.
        • Roeleveld J.
        • Visscher P.M.
        Identification of twin pairs from large population-based samples.
        Twin Res Hum Genet. 2006; 9: 496-500
        • Centers for Disease Control and Prevention
        Quicktats: Total and Primary cesarean rate and vaginal birth after previous cesarean (VBAC) rate—United States, 1989-2003.
        in MMWR Morb Mortal Wkly Rep. 2005; 54: 46
        • Moore J.
        • Baldisseri M.R.
        Amniotic fluid embolism.
        Crit Care Med. 2005; 33: S279-S285
        • Tuffnell D.J.
        Amniotic fluid embolism.
        Curr Opin Obstet Gynecol. 2003; 15: 119-122
        • National Center for Health Statistics
        Crude birth rates, fertility rates, and birth rates by age, race, and Hispanic origin of mother: United States, selected years 1970-2004. 2006; (Health, United States): 134
        • Oyelese Y.
        • Smulian J.C.
        Placenta previa, placenta accreta, and vasa previa [see comment].
        Obstet Gynecol. 2006; 107: 927-941
        • Getahun D.
        • Oyelese Y.
        • Salihu H.M.
        • Ananth C.V.
        Previous cesarean delivery and risks of placenta previa and placental abruption [see comment].
        Obstet Gynecol. 2006; 107: 771-778
        • Cleary-Goldman J.
        • Malone F.D.
        • Vidaver J.
        • et al.
        Impact of maternal age on obstetric outcome.
        Obstet Gynecol. 2005; 105: 983-990

      Linked Article

      • Amniotic fluid embolism: active surveillance versus retrospective database review
        American Journal of Obstetrics & GynecologyVol. 199Issue 4
        • Preview
          Abenhaim et al1 reported an incidence of amniotic fluid embolism (AFE) of 7.7 per 100,000 births in a retrospective, population-based cohort study. Both this, and other population-based studies reported in the literature,2 ascertained cases through interrogation of a coded hospital admissions database. As other authors2 point out, diagnosis of amniotic fluid embolism is difficult, and coded data may be flawed,3 thus limiting the accuracy of incidence estimates obtained from retrospective database review.
        • Full-Text
        • PDF