Amniotic fluid embolism (AFE) is a rare and catastrophic complication of pregnancy presenting as a complex sequence of events resulting in cardiopulmonary and coagulation compromise during the intrapartum period. Mortality is high. Consequently, women who have suffered an AFE and survive commonly refrain from further child bearing despite a lack of evidence suggesting a risk of reoccurrence (Moaddab 2017 EJOGRB). The aim of this study was to determine AFE reoccurrence rates using data from the international AFE Registry established at Baylor College of Medicine and AFE Foundation, along with published reports of pregnancies following AFE.
Patients enrolled in the AFE Registry between 2013-2017 and classified as having had a classic AFE (Clark 2016 AJOG) were interviewed about pregnancy before and after AFE. PubMed and OVID search engines were used to identify cases of pregnancy reported in the literature after AFE.
Fifty-four women with classic AFE were identified in the Registry. Of these, 5 died, leaving 49 women available for interview. Seven women had subsequent pregnancies, 1 miscarried and the other 6 had uncomplicated pregnancies and delivered at term. Nine cases of pregnancy following AFE were found in the literature, all without reoccurrence bringing the total reported cases of pregnancy following AFE to 16. Therefore the documented rate of reoccurrence for AFE is 0% (0/16) with 95% CI = 0-20% (Hanley & Lippman-Hand 1983 JAMA).
These data represent the largest existing series of pregnancy outcome following AFE, almost double the existing reported experience. Although the numbers remain small, there exists no documented case of AFE recurrence in the literature. These data, along with the appropriate CI may prove helpful in counseling AFE survivors considering pregnancy.
© 2017 Published by Elsevier Inc.