Kim Jin-Ha, Seol Hyun-Joo, Seong Won Joon, Ryu Hyun-Mee, Bae Jin-Gon, Hong Joon Seok, Yang Jeong In, Sung Ji-Hee, Choi Suk-Joo, Oh Soo-Young, Roh Cheong-Rae
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Seoul, Korea.
Obstet Gynecol Sci. 2021 Mar;64(2):190-200. doi: 10.5468/ogs.20195. Epub 2020 Dec 28.
This study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosed by maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteria by the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomes between cases satisfying all 4 criteria and cases with at least 1 missing criterion.
This study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collected information, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality.
The median maternal age was 33 years (range, 28-40 years). Regarding symptoms, cardiovascular arrest, hypotension, respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%, and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability, showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7% of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (<30 minutes after delivery). There was no difference in maternal mortality and the amount of transfusion between cases satisfying all 4 criteria and cases with at least 1 missing criterion.
Two-thirds of clinically confirmed AFE cases did not satisfy all 4 criteria proposed by the SMFM, despite similar rates of maternal mortality with cases satisfying all 4 criteria. Our study suggests that there may be some discrepancy between the clinical diagnosis of AFE and the recent diagnostic criteria proposed by the SMFM for research purpose.
本研究旨在1）调查韩国母胎医学（MFM）专家临床诊断的羊水栓塞（AFE）病例的临床特征；2）为研究目的，检查与母胎医学协会（SMFM）最近提出的4项标准的不一致性；3）比较符合所有4项标准的病例与至少有1项标准缺失的病例的孕产妇结局。
本研究纳入了韩国7家转诊医院临床诊断为AFE的12例患者。我们收集了包括产妇年龄、AFE症状、输血量和孕产妇死亡率等信息。
孕产妇年龄中位数为33岁（范围28 - 40岁）。关于症状，分别在41.7%、83.3%、83.3%、100%和66.7%的病例中观察到心血管骤停、低血压、呼吸功能不全、临床凝血病和神经体征。在这12例病例中，5名女性死亡，2名患有严重神经残疾，完整生存率为41.7%。66.7%的病例与SMFM提出的所有4项标准存在不一致，原因是缺乏弥散性血管内凝血标准或严格的发病时间（分娩后<30分钟）。符合所有4项标准的病例与至少有1项标准缺失的病例在孕产妇死亡率和输血量方面没有差异。
三分之二临床确诊的AFE病例不符合SMFM提出的所有4项标准，尽管与符合所有4项标准的病例孕产妇死亡率相似。我们的研究表明，AFE的临床诊断与SMFM最近提出的用于研究目的的诊断标准之间可能存在一些差异。
