研究中羊水栓塞病例定义的拟议诊断标准。

Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies.

作者信息

Clark Steven L, Romero Roberto, Dildy Gary A, Callaghan William M, Smiley Richard M, Bracey Arthur W, Hankins Gary D, D'Alton Mary E, Foley Mike, Pacheco Luis D, Vadhera Rakesh B, Herlihy J Patrick, Berkowitz Richard L, Belfort Michael A

机构信息

Baylor College of Medicine, Houston, TX; Perinatology Research Branch of the Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Detroit, MI, and Bethesda, MD; Columbia University, New York, NY; Centers for Disease Control and Prevention, Atlanta, GA; Banner Health, Phoenix, AZ; University of Texas Medical Branch, Galveston, TX.

Baylor College of Medicine, Houston, TX; Perinatology Research Branch of the Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Detroit, MI, and Bethesda, MD; Columbia University, New York, NY; Centers for Disease Control and Prevention, Atlanta, GA; Banner Health, Phoenix, AZ; University of Texas Medical Branch, Galveston, TX.

出版信息

Am J Obstet Gynecol. 2016 Oct;215(4):408-12. doi: 10.1016/j.ajog.2016.06.037. Epub 2016 Jun 29.

Abstract

Amniotic fluid embolism is a leading cause of maternal mortality in developed countries. Our understanding of risk factors, diagnosis, treatment, and prognosis is hampered by a lack of uniform clinical case definition; neither histologic nor laboratory findings have been identified unique to this condition. Amniotic fluid embolism is often overdiagnosed in critically ill peripartum women, particularly when an element of coagulopathy is involved. Previously proposed case definitions for amniotic fluid embolism are nonspecific, and when viewed through the eyes of individuals with experience in critical care obstetrics, would include women with a number of medical conditions much more common than amniotic fluid embolism. We convened a working group under the auspices of a committee of the Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation whose task was to develop uniform diagnostic criteria for the research reporting of amniotic fluid embolism. These criteria rely on the presence of the classic triad of hemodynamic and respiratory compromise accompanied by strictly defined disseminated intravascular coagulopathy. It is anticipated that limiting research reports involving amniotic fluid embolism to women who meet these criteria will enhance the validity of published data and assist in the identification of risk factors, effective treatments, and possibly useful biomarkers for this condition. A registry has been established in conjunction with the Perinatal Research Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development to collect both clinical information and laboratory specimens of women with suspected amniotic fluid embolism in the hopes of identifying unique biomarkers of this condition.

摘要

羊水栓塞是发达国家孕产妇死亡的主要原因。由于缺乏统一的临床病例定义,我们对其危险因素、诊断、治疗和预后的理解受到阻碍;无论是组织学检查还是实验室检查结果,都未发现该病症特有的表现。在危重症围产期妇女中,羊水栓塞常常被过度诊断,尤其是在涉及凝血功能障碍的情况下。先前提出的羊水栓塞病例定义不具有特异性,从重症产科有经验的人员角度来看,会将许多比羊水栓塞更为常见的病症的女性纳入其中。我们在母胎医学会和羊水栓塞基金会的一个委员会的支持下召集了一个工作组,其任务是为羊水栓塞的研究报告制定统一的诊断标准。这些标准依赖于存在血流动力学和呼吸功能障碍的经典三联征,并伴有严格定义的弥散性血管内凝血。预计将涉及羊水栓塞的研究报告仅限于符合这些标准的女性,将提高已发表数据的有效性,并有助于识别该病症的危险因素、有效治疗方法以及可能有用的生物标志物。已与尤妮斯·肯尼迪·施赖弗国家儿童健康与人类发展研究所的围产期研究部门联合建立了一个登记处,以收集疑似羊水栓塞女性的临床信息和实验室标本,希望能识别出该病症特有的生物标志物。

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