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331: Differences in clinical presentation and outcomes between women with typical versus atypical amniotic fluid embolism

      Objective

      Amniotic fluid embolism (AFE) remains an unpredictable and unpreventable cause of maternal morbidity and mortality. The aim of this study was to investigate differences in clinical presentation and outcomes between women with typical versus atypical AFE using the AFE registry, an international database established at Baylor College of Medicine in partnership with the AFE Foundation and the PRB of the NICHD/NIH.

      Study Design

      Cases submitted to the registry between August 2013 and September 2017 were classified into 1) typical; 2) atypical; 3) non-AFE; or 4) indeterminate using the previously published and validated criteria for the research reporting of AFE. Demographic, clinical variables and outcomes for patients with typical and atypical AFE were compared.

      Results

      129 charts were available for review. Of these, 45.7 % were typical AFE, 11.6 % were atypical AFE, 20.9 % were classified as non-AFE cases with an alternative diagnosis, and 21.7% were considered uncertain. Although there was no significant differences in demographic or obstetrical variables, maternal hypotension was a significantly less common presenting condition among atypical AFE cases (P = .001). Pulmonary edema and maternal neurologic injury were significantly more frequent among women with typical AFE (p =0.04, 0.02 respectively).

      Conclusion

      The current study represents the largest case series of patients with AFE whose diagnosis has been determined by detailed review using the recently published and validated criteria for the research reporting of AFE. With the exception of pulmonary findings, hypotension at presentation and improved neurologic outcomes, typical and atypical cases did not differ.
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