Zaami S, Marinelli E, Montanari Vergallo G
Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome.
Clin Ter. 2017 May-Jun;168(3):e220-e224. doi: 10.7417/T.2017.2010.
Amniotic fluid embolism (AFE) is a pregnancy complication known to be extremely hard to diagnose, since it manifests itself abruptly and with no warning signs, presenting an incidence rate of about 1 in 40000 deliveries, and maternal morbidity and mortality ranging from 20% to 60%. Although almost a century has gone by since it was first identified (1926) and despite medical research having been conducted on such a syndrome, diagnostic procedures and treatment methods have not yet been clarified enough. Specific biochemical markers have been produced in research laboratories, but their clinical value results to be limited, given how rapid the pathological process moves forward. At the time being, no diagnosis is feasible which may effectively prevent the disease from occurring. Certainly, a multidisciplinary approach might contribute to saving the lives of mother and infant, as well as ensuring better life standards. The paper's authors aim to highlight the medico-legal issues, in light of several rulings from the Italian Constitutional Court as well as lower courts. The authors also advocate for the creation of a nation-wide registry meant to collect all signaled AFE instances so that research on this as yet devastating syndrome can be conducted based on hard data.
羊水栓塞(AFE)是一种已知极难诊断的妊娠并发症,因为它发病突然且无预警迹象,发病率约为每40000例分娩中有1例,孕产妇发病率和死亡率在20%至60%之间。尽管自首次发现(1926年)以来已过去近一个世纪,且针对该综合征开展了医学研究,但诊断程序和治疗方法仍未得到充分阐明。研究实验室已产生了特定的生化标志物,但其临床价值有限,因为病理过程进展迅速。目前,尚无可行的诊断方法能有效预防该病发生。当然,多学科方法可能有助于挽救母婴生命,并确保更好的生活标准。鉴于意大利宪法法院以及下级法院的多项裁决,本文作者旨在强调法医学问题。作者还主张建立一个全国性登记处,用于收集所有报告的羊水栓塞病例,以便基于确凿数据对这种迄今仍具有毁灭性的综合征进行研究。