TITLE:
Amniotic Fluid Embolism (AFE): A Review of the Literature Orientated on Two Clinical Presentations—Typical and Atypical
AUTHORS:
Waldemar Uszyński, Mieczysław Uszyński
KEYWORDS:
Amniotic Fluid Embolism; Mother Mortality; Classification; Presentation
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.1,
January
22,
2014
ABSTRACT: Background/Aim: Recently, a comparative study on the
incidence of AFE has highlighted rather confusing results, showing that the
complication is more than three times higher
in North America than that in some European countries. In this paper, we
put forward the hypothesis that this discrepancy is due to inaccurate diagnosis
of non-classical form of AFE (atypical AFE). We also provide an outline of
symptoms that characterize this type of AFE based on the analysis of all
available case reports. Material and Methods: We searched Medline from 1969
(its inception) to 2011, using the key words “amniotic fluid embolism”. The
search produced 1127 articles, including 208 case reports of AFE and other
publications identified as eligible for our study (11 review articles and 6
population-based studies of the last few years). Moreover, we looked through
the articles from the period before “inception of Medline” to find 178 earlier
case reports. Full texts were analyzed. Results and Conclusions: (i) Worldwide,
447 cases of AFE have been reported, including 70 cases of atypical AFE (15.7%).
(ii) Typical AFE is characterized by three clinical phases (cardiopulmonary
collapse, clotting disorders and hemorrhages,
multiorgan disturbances), whereas the atypical one shows lack of
cardiopulmonary collapse as the initial presentation—the first to appear is
obstetric hemorrhage and/or pulmonary and
renal dysfunction. (iii) Four subclasses of atypical AFE were distinguished
on the basis of case reports: uterine hemorrhage-type of AFE, ARDS as the only
presentation of atypical AFE, paradoxical
AFE, and cesarean section-related atypical AFEs.