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

of over ten litres. Despite a hysterectomy, and excellent Critical Care, she died shortly afterwards.
Autopsy confi rmed the presence of fetal squamous cells in her pulmonary vasculature.
The ages of the women who died this triennium ranged from 17 to 39 years with a median age of 33 years.
Thirteen were multiparous. All but one had reached their estimated due delivery date of between 38-41
weeks’ gestation with the other woman having a slightly premature delivery. Fifteen women died within 24
hours of collapse.
All the women were in stable relationships and only one family was unemployed. Five were from Black and
Minority Ethnic groups, four of whom did not speak English. All but three sought and received appropriate
and timely antenatal care. The other women, all Black African mothers with previous children, had booked
for maternity care at around six months of pregnancy.
The clinical circumstances
Only one of the women whose deaths are discussed in this Chapter died undelivered. Four women who
collapsed before the onset of labour were delivered by emergency caesarean section. Of the others,
fi ve had a spontaneous vaginal delivery, two required low cavity forceps and the remaining women were
delivered by caesarean section, ten of which were peri or post mortem sections carried out during active
maternal resuscitation. Four women collapsed after delivery, two within minutes and the others between
one and four hours. Hysterectomy was also performed in four cases.
Ten babies survived including one set of twins and the three babies who were delivered before their
mothers collapsed. Unusually, a third of the babies who were delivered by peri or post mortem caesarean
section also survived, probably because their mothers collapsed in a delivery suite or maternity ward fully
equipped for rapid emergency caesarean sections and neonatal resuscitation.
Eight women had received uterine stimulation, fi ve with prostaglandins and three with oxytocin. Nine had
ruptured membranes, two artifi cially. In 11 cases, premonitory symptoms were recorded which included
breathlessness, chest pain, feeling cold, light headedness, restlessness, distress, panic, a feeling of pins
and needles in the fi ngers and nausea and vomiting. The interval between the onset of these symptoms
and delivery varied from almost immediately to over four hours later.
All the cases described here involved resuscitation and advanced life support. In many cases there were
excellent examples of multidisciplinary team working and excellent support was provided for both staff
and relatives.
Box 5.1
Learning points: AFE
In many cases, women who suffer an amniotic fl uid embolism report some or all of the following
premonitory symptoms:
Breathlessness, chest pain, feeling cold, light headedness, restlessness, distress, panic, a feeling of
pins and needles in the fi ngers, nausea and vomiting.
In several cases the severity of the mother’s condition was not recognised until too late which
compromised the delivery of timely and effective resuscitation.
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