Kristufkova Alexandra, Borovsky Miroslav, Korbel Miroslav, Knight Marian
1st Department of Gynaecology and Obstetrics, Faculty of Medicine, Comenius University in Bratislava, Slovak Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014 Sep;158(3):397-403. doi: 10.5507/bp.2013.050. Epub 2013 Sep 27.
Amniotic fluid embolism (AFE) is a rare, often severe complication of pregnancy. The clinical diagnosis is difficult to establish and is one of exclusion. The aim of this study was to investigate 6 fatal cases of AFE in Slovakia and compare the incidence, risk factors, course, management and neonatal outcomes with fatal cases of AFE in the United Kingdom (UK).
Data on fatal cases of AFE in Slovakia were analysed and compared with fatal cases in the UK in the years 2005-2010.
The incidence in Slovakia was significantly higher than in the UK from 2005-2010 (RR 5.03, 95% CI 1.98-12.75, P=0.003). However, 5/6 deaths occurred in 2009 coinciding with the H1N1 flu virus pandemic in Slovakia. There were no significant differences in the characteristics of women who died, with the exception of gestational age at delivery; significantly higher in Slovakia (median 41 versus 39 weeks, P=0.01). In Slovakia most of the cases occurred after delivery, 83.3%, compared with 52.9% in the UK. There were no significant differences in clinical signs, use of recombinant factor VIIa or performance of obstetric hysterectomy. In Slovakia 83.3% and in the UK 94.7% of infants survived, but 20% and 27.8% had some long-term sequelae.
AFE is now the leading cause of maternal deaths in Slovakia. However, we found no significant differences in the possible risk factors, course, management or outcomes between Slovakia and the UK. This analysis is limited by study power; we propose that establishment of a national register of cases of AFE in Slovakia would help further investigate and monitor mortality from this condition.
羊水栓塞（AFE）是一种罕见且通常较为严重的妊娠并发症。临床诊断很难确立，属于排除性诊断之一。本研究的目的是调查斯洛伐克6例AFE死亡病例，并将其发病率、危险因素、病程、治疗及新生儿结局与英国（UK）的AFE死亡病例进行比较。
分析了斯洛伐克AFE死亡病例的数据，并与2005 - 2010年英国的死亡病例进行比较。
2005 - 2010年斯洛伐克的发病率显著高于英国（相对危险度5.03，95%可信区间1.98 - 12.75，P = 0.003）。然而，6例死亡中有5例发生在2009年，这与斯洛伐克的甲型H1N1流感病毒大流行时间一致。死亡女性的特征除分娩时的孕周外无显著差异；斯洛伐克的孕周显著更高（中位数41周对39周，P = 0.01）。在斯洛伐克，大多数病例发生在分娩后，占83.3%，而英国为52.9%。临床体征、重组凝血因子VIIa的使用或产科子宫切除术的实施方面无显著差异。斯洛伐克83.3%的婴儿存活，英国为94.7%，但分别有20%和27.8%的婴儿有一些长期后遗症。
AFE目前是斯洛伐克孕产妇死亡的主要原因。然而，我们发现斯洛伐克和英国在可能的危险因素、病程、治疗或结局方面没有显著差异。本分析受研究效能的限制；我们建议在斯洛伐克建立全国性的AFE病例登记册，这将有助于进一步调查和监测这种疾病的死亡率。
