Department of Gynaecology & Obstetrics, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France.
Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(2):189-92. doi: 10.1016/j.ejogrb.2013.02.017. Epub 2013 Mar 19.
To provide updated data on amniotic fluid embolism (AFE) based on our population over a 10 year period, and to propose steps for improving current practice.
Retrospective study carried out in the Department of Gynaecology and Obstetrics at the Strasbourg University Teaching Hospital between 1 January 2000 and 31 December 2010. Dossiers of patients with AFE were identified using medical information system programme (MISP) coding and cross-checked with the pathology reports (hysterectomy, post-mortem examination).
Eleven dossiers were found (0.28/1000). Eight cases (73%) of AFE occurred during labour, two (18%) in the post-partum period and one (9%) outside of parturition. Induction was initiated in four patients (45%) and labour sustained with oxytocin in 9 patients (90%). Acute circulatory collapse with cardio-respiratory arrest (CRA) was the herald symptom of AFE in 2 patients, and secondary cardio-respiratory arrest occurred rapidly in 6 patients (55%) following a relatively non-indicative prodromal phase. Disseminated intravascular coagulopathy (DIC) was observed in 10 cases (91%) and massive transfusion was necessary in all patients. Seven haemostatic hysterectomies (63%) were performed, with secondary arterial embolisation in 2 cases (22%). Although all patients presented a clinical picture of AFE, confirmation through histology or laboratory test results was forthcoming in only 7 cases (63%). Three patients died (27%). When AFE occurred during labour, 8 fetuses (75%) received intensive care support. In all, 11 newborns survived (85%). Their pH was less than 7.00 in 3 cases (27%) and 4 fetuses (36%) had an Apgar score of less than 5 at 5 minutes of life.
AFE is a rare but extremely serious disease. Some risk factors for AFE have been identified but they do not allow its occurrence to be predicted. The diagnosis may be supported by specific laboratory test results but only a post-mortem examination provides a pathognomonic diagnosis: unfortunately it is always retrospective. Obstetrical and intensive care management is complex and must be adapted to the situation bearing in mind the significant risk of haemorrhage and DIC. Hysterectomy must be performed if there is the least doubt.
基于我们的人群，提供关于羊水栓塞（AFE）的最新数据，并提出改进当前实践的步骤。
2000 年 1 月 1 日至 2010 年 12 月 31 日，在斯特拉斯堡大学教学医院妇产科进行回顾性研究。使用医疗信息系统程序（MISP）编码识别 AFE 患者的档案，并与病理报告（子宫切除术、尸检）进行交叉核对。
发现 11 份档案（0.28/1000）。8 例（73%）AFE 发生在分娩期间，2 例（18%）发生在产后，1 例（9%）发生在分娩之外。4 例患者（45%）开始引产，9 例患者（90%）用催产素维持分娩。2 例患者出现急性循环衰竭伴心肺骤停（CRA），为 AFE 的先兆症状，6 例患者（55%）在相对非提示性前驱期后迅速发生继发性心肺骤停。10 例（91%）患者出现弥散性血管内凝血（DIC），所有患者均需大量输血。行 7 例（63%）止血性子宫切除术，2 例（22%）行继发性动脉栓塞术。尽管所有患者均表现出 AFE 的临床症状，但仅在 7 例（63%）患者中通过组织学或实验室检查结果得到证实。3 例患者死亡（27%）。当 AFE 发生在分娩期间，8 例胎儿（75%）接受了重症监护支持。共 11 例新生儿存活（85%）。其中 3 例（27%）新生儿 pH 值<7.00，4 例（36%）新生儿出生后 5 分钟 Apgar 评分<5。
AFE 是一种罕见但极其严重的疾病。已经确定了一些 AFE 的危险因素，但不能预测其发生。诊断可通过特定的实验室检查结果支持，但只有尸检提供特征性诊断：不幸的是，它总是回顾性的。产科和重症监护管理复杂，必须根据情况进行调整，同时牢记严重出血和 DIC 的风险。如果有任何疑问，必须进行子宫切除术。
