Saving Mothers' Lives: - Public Health Agency for Northern Ireland

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5 Amniotic fl uid embolism
Robin Vlies
Amniotic fl uid embolism (AFE): Specifi c recommendations
Clinical practice and ongoing education and training
The management of amniotic fl uid embolism is the same as the management of any woman who
collapses before, during, or after labour. All staff require regular training for the identifi cation and
management of severe maternal illness or collapse. This is also a key recommendation of this Report.
Pathology
At autopsy fetal squames and lanugo hair should be searched for in any pregnant or recently delivered
woman. All possible attempts should be made to confi rm a diagnosis of amniotic fl uid embolism at
autopsy. Histology, and if necessary, immunocytochemistry staining should be available.
National Amniotic Fluid Embolism Study
All cases of suspected or proven amniotic fl uid embolism, whether fatal or not, should be reported
through the monthly card notifi cation system to:
The United Kingdom Obstetric Surveillance System (UKOSS)
The National Perinatal Epidemiology Unit
University of Oxford
Old Road Campus
Old Road
Headington
Oxford, OX3 7LF
Summary of key fi ndings for 2003-05
In this triennium, the deaths of 19 mothers who died of amniotic fl uid embolism (AFE) were reported to
this Enquiry. Of these, 17 were Direct deaths while a further two, although discussed here, are counted as
Late Direct deaths in Chapter 14. This is because although both these mothers survived the initial event, it
resulted in a persistent vegetative state from which they died many weeks later.
As shown in Table 5.1, compared with the fi ve cases reported in 2000-02 and eight in 1997-99, the 17
deaths and the mortality rate of 0.80 per 100,000 maternities attributed to amniotic fl uid embolism this
triennium appears high. The difference between the rate for 2003-05 and that for the previous triennium,
shown in Table 5.1 was 0.55, with a 95 confi dence interval from 0.10 to 1.06, which was only just
statistically signifi cant. In addition, the 17 Direct deaths were not evenly spread throughout the three year
period, with only three occurring in 2005, so this does not represent a consistent upwards trend. Thus,
although AFE is the second leading cause of Direct maternal death for the fi rst time since it was identifi ed
as a cause of death in these Reports, it cannot be assumed that this pattern will persist.