Department of Pediatrics, McGill University Faculty of Medicine, Montreal, QC, Canada.
Paediatr Perinat Epidemiol. 2013 Sep;27(5):436-41. doi: 10.1111/ppe.12066. Epub 2013 Jul 3.
Amniotic fluid embolism (AFE) is a rare but serious cause of maternal mortality whose aetiology remains obscure. Previous population-based studies have reported associations with labour induction and caesarean delivery.
We updated a previous analysis based on the US Nationwide Inpatient Sample from 1999 to 2008. We adapted a diagnostic validation algorithm to minimise false-positive diagnoses, along with statistical methods that account for the stratified random sampling design.
Of the 8 571 209 deliveries recorded in the database, 276 met our case definition of AFE, of which 62 (22.9% of the 274 with known vital status) were fatal. Significant associations with AFE were observed for medical induction {adjusted odds ratio [aOR] = 1.7 [95% confidence interval (CI) 1.2, 2.5]}, caesarean delivery [aOR = 15.0; 95% CI 9.4, 23.9], instrumental vaginal delivery [aOR = 6.6; 95% CI 4.0, 11.1], and cervical/uterine trauma [aOR = 7.4; 95% CI 3.6, 14.9]. AFE was associated with increases in risk of stillbirth, hysterectomy, maternal death, and prolonged maternal length of delivery hospital stay.
AFE remains an extremely serious obstetric complication with high risks of maternal and fetal mortality. The increased risks of AFE associated with labour induction and caesarean delivery have implications for elective use of these interventions.
羊水栓塞（AFE）是一种罕见但严重的产妇死亡原因，其病因仍不清楚。以前的基于人群的研究报告了与引产和剖宫产有关的关联。
我们更新了之前基于 1999 年至 2008 年美国全国住院患者样本的分析。我们采用了诊断验证算法来最小化假阳性诊断，并结合了考虑分层随机抽样设计的统计方法。
在数据库中记录的 8571209 次分娩中，有 276 次符合我们的 AFE 病例定义，其中 274 例已知生命状态的 62 例（22.9%）是致命的。与 AFE 显著相关的因素包括医疗引产（调整后的优势比[aOR] = 1.7 [95%置信区间（CI）1.2, 2.5]）、剖宫产（aOR = 15.0；95%CI 9.4, 23.9）、器械性阴道分娩（aOR = 6.6；95%CI 4.0, 11.1）和宫颈/子宫创伤（aOR = 7.4；95%CI 3.6, 14.9）。AFE 与死产、子宫切除、产妇死亡和产妇分娩住院时间延长的风险增加有关。
AFE 仍然是一种极其严重的产科并发症，母婴死亡率极高。与引产和剖宫产相关的 AFE 风险增加，对这些干预措施的选择性使用具有影响。
