Morau E, Proust A, Ducloy J-C
Pole Mère-Enfant, service d'anesthésie-réanimation, CHU de Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34000 Montpellier, France.
Maternité Les Vallées, hôpital privé d'Antony, 1, rue Velpeau, 92160 Antony, France.
Gynecol Obstet Fertil Senol. 2017 Dec;45(12S):S43-S47. doi: 10.1016/j.gofs.2017.10.014. Epub 2017 Nov 14.
Amniotic fluid embolism (AFE) is an unpredictable, dreadful complication of pregnancy or childbirth. EA typically includes in the same lapse of time respiratory, haemodynamic, neurological and hemorrhagic symptoms (from early and severe coagulopathy). Immediate supportive treatment by a multidisciplinary team is the cornerstone of the management. Between 2010 an 2012 in France, 24 deaths were related to AFE giving a maternal mortality ratio of 1/100,000 live births (CI 95% 0.6-1.4). AFE ranks as the second leading cause of direct maternal death. Eight cases over 23 were classified as having some degree of substandard care. Substandard care included delays in performing aggressive surgical treatment or delays in the diagnosis and the treatment of the coagulopathy. Learning points focus on the importance to pay attention on premonitory symptoms, to early assess the clotting status and to train in multidisciplinary team.
羊水栓塞（AFE）是妊娠或分娩中一种不可预测的可怕并发症。典型的羊水栓塞通常在同一时间段内出现呼吸、血流动力学、神经和出血症状（源于早期严重的凝血病）。多学科团队进行的即时支持治疗是管理的基石。2010年至2012年期间，法国有24例死亡与羊水栓塞相关，孕产妇死亡率为1/100,000活产（95%置信区间0.6 - 1.4）。羊水栓塞是直接孕产妇死亡的第二大主要原因。23例中有8例被归类为存在某种程度的护理不达标。护理不达标包括进行积极手术治疗的延迟或凝血病诊断及治疗的延迟。经验教训集中在重视先兆症状、早期评估凝血状态以及多学科团队培训的重要性上。
