Tuffnell Derek J
Bradford Hospitals NHS Trust, Bradford, UK.
Curr Opin Obstet Gynecol. 2003 Apr;15(2):119-22. doi: 10.1097/00001703-200304000-00006.
To review the recent literature on amniotic fluid embolism and how it may influence the clinical management and further study of the condition. Morbidity and mortality from amniotic fluid embolism in the international context will be described, given the recent Confidential Enquiries into Maternal Deaths in the United Kingdom and other studies. With this rare condition we need to look for clues as to how to facilitate diagnosis and improve outcomes.
Amniotic fluid embolism continues to be a leading cause of maternal death. There has been a decrease in mortality from amniotic fluid embolism in the UK from 5.1 to 3.7 per million maternities, but it is still the fifth greatest cause of direct maternal death. In France, 13% of deaths are caused by amniotic fluid embolism, the third highest cause. In Singapore, a study of postmortems found that over 30% of direct maternal deaths were caused by amniotic fluid embolism, the most common cause. Case-specific mortality may not be as high as previously thought. The early data from the UK Register of cases show only 16% mortality, although there is significant maternal and neonatal morbidity. Early diagnosis may be the best way to improve outcomes. Case reports suggest that plasma exchange techniques may be helpful after initial resuscitation.
With a rare condition additions to the literature are sparse. Early consideration of the diagnosis after prompt resuscitation is needed. Further data are needed to advance beyond this.
回顾近期关于羊水栓塞的文献，以及其如何影响该病症的临床管理和进一步研究。鉴于英国近期的孕产妇死亡保密调查及其他研究，将描述国际范围内羊水栓塞导致的发病率和死亡率。对于这种罕见病症，我们需要寻找有助于诊断和改善预后的线索。
羊水栓塞仍然是孕产妇死亡的主要原因。英国羊水栓塞的死亡率已从每百万例孕产妇中的5.1例降至3.7例，但它仍是孕产妇直接死亡的第五大原因。在法国，13%的死亡由羊水栓塞导致，是第三大死因。在新加坡，一项尸检研究发现，超过30%的孕产妇直接死亡由羊水栓塞导致，是最常见的原因。具体病例的死亡率可能没有此前认为的那么高。英国病例登记的早期数据显示死亡率仅为16%，尽管存在显著的孕产妇和新生儿发病率。早期诊断可能是改善预后的最佳方法。病例报告表明，血浆置换技术在初始复苏后可能有用。
对于这种罕见病症，文献新增内容稀少。在迅速复苏后需要尽早考虑诊断。需要更多数据才能取得进一步进展。
