Zhu Chengya, Xu Dong, Luo Qiong
Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, No. 1 Xueshi Road, Hangzhou, 310000, China.
Arch Gynecol Obstet. 2023 Apr;307(4):1187-1194. doi: 10.1007/s00404-022-06535-y. Epub 2022 Apr 9.
This study aimed to estimate the incidence of fatal amniotic fluid embolism, describe its risk factors, and analyze perinatal outcomes.
Maternity cases and newborn records of amniotic fluid embolism were collected from the Zhejiang Maternal Surveillance System from October 2006 to October 2019. This study strictly limited the diagnostic criteria for AFE and excluded suspicious cases in order to minimize false-positive AFE cases. The risk factors of fatal amniotic fluid embolism and the relationship between perinatal prognosis and AFE were investigated using logistic regression analysis, estimating the adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
149 cases of amniotic fluid embolism were registered, of which 80 cases were fatal. The estimated fatal AFE incidence was 0.99 per 100,000. The occurrence of fatal AFE was significantly correlated with spontaneous vaginal delivery (aOR 12.3, 95% CI 3.3-39.2) and cardiac arrest (aOR 64.8, 95% CI 14.6-287.8). The average diagnosis time of fatal AFE is 85.51 min, and the peak period of female death is 1-12 h after the onset of the disease, accounting for 60% (48/80) of cases. Fatal amniotic embolism is a cause of intrauterine fetal death and fetal death during delivery (aOR 11.957, 95% CI 1.457-96.919; aOR 13.152, 95% CI 1.636-105.723). Of the 149 confirmed AFE cases, 11 cases of stillbirth occurred, 12 cases were stillborn, and 7 cases of neonatal death were reported. The perinatal mortality rate was 202 per 1000.
Early detection, diagnosis, and treatment of amniotic fluid embolism are essential to avoiding fatal AFE. Clinicians should fully evaluate the pros and cons of choosing the delivery method for pregnant women. When cardiac arrest occurs in women with amniotic fluid embolism, obstetricians should be particularly careful and provide timely and effective treatment to minimize the fatality rate. The outcome of AFE is not only related to maternal survival but also plays a decisive role in the prognosis of the infant over the perinatal period.
本研究旨在估算致死性羊水栓塞的发生率，描述其危险因素，并分析围产期结局。
收集2006年10月至2019年10月浙江省孕产妇监测系统中羊水栓塞的孕产妇病例及新生儿记录。本研究严格限定了羊水栓塞的诊断标准，排除可疑病例，以尽量减少羊水栓塞假阳性病例。采用逻辑回归分析研究致死性羊水栓塞的危险因素以及围产期预后与羊水栓塞之间的关系，估算校正比值比（aORs）和95%置信区间（CIs）。
共登记149例羊水栓塞病例，其中80例死亡。致死性羊水栓塞的估计发生率为每10万例中有0.99例。致死性羊水栓塞的发生与自然阴道分娩（aOR 12.3，95%CI 3.3 - 39.2）和心脏骤停（aOR 64.8，95%CI 14.6 - 287.8）显著相关。致死性羊水栓塞的平均诊断时间为85.51分钟，女性死亡高峰期为发病后1 - 12小时，占病例的60%（48/80）。致死性羊水栓塞是宫内胎儿死亡和分娩期间胎儿死亡的原因之一（aOR 11.957，95%CI 1.457 - 96.919；aOR 13.152，95%CI 1.636 - 105.723）。在149例确诊的羊水栓塞病例中，发生11例死产，12例为死胎，报告7例新生儿死亡。围产儿死亡率为每1000例中有202例。
羊水栓塞的早期检测、诊断和治疗对于避免致死性羊水栓塞至关重要。临床医生应充分评估为孕妇选择分娩方式的利弊。当羊水栓塞女性发生心脏骤停时，产科医生应格外小心，并提供及时有效的治疗，以尽量降低死亡率。羊水栓塞的结局不仅与产妇存活有关，而且在围产期婴儿预后中也起决定性作用。
