6.-March-2011-Saving-Mothers-Lives-reviewing-maternal-deaths-to-make-motherhood-safer-2006-2008

Chapter 5: Amniotic fluid embolismChapter 5: Amniotic fluid embolismAJ Dawson (on behalf of the Centre for Maternal and Child Enquiries)Consultant Obstetrician, Nevill Hall Hospital, Abergavenny, UKCorrespondence: Amendment after online publication (11 March 2011): the correct address for this author is Nevill Hall Hospital, AbergavennyNP7 7EG, UK. Email: andrewdawson.work@btinternet.comKeywords amniotic fluid embolism, Confidential Enquiry, maternal,mortality.Amniotic fluid embolism: specific recommendations• All maternal death autopsies should be performed as soon after death as possible, and not delayed by several days,because the diagnosis of AFE then becomes difficult if not impossible.At autopsy:• confirm the diagnosis using immunochemistry• in clinically classical cases where no squames can be found, search for mucins.Amniotic fluid embolism: learningpointsAmniotic fluid embolism (AFE) should no longer beregarded as a condition with near universal maternalmortality. High-quality supportive care can result ingood outcomes for both mother and baby dependingon the place of collapse.There were several examples of excellent practice thistriennium, including prompt peri-mortem caesareansection.AFE may be confused with other presentations, includingeclampsia, septic or anaphylactic shock and pulmonaryembolism, but ultimately the immediate actiontaken should be resuscitative and the initial treatment isunlikely to differ.Summary of key findings for 2006–08In this triennium, the deaths of 13 mothers who died ofAFE were reported to the Enquiry, giving a mortality rateof 0.57 per 100 000 maternities (95% CI 0.33–0.98).Although AFE continues to rank as a major cause of Directmaternal deaths, it has fallen from being the second to thefourth leading cause of Direct deaths this triennium.As shown in Table 5.1, the numbers and mortality rate forthis triennium are less than the 17 deaths and mortality rateof 0.80 per 100 000 maternities (95% CI 0.50–1.29) attributedto AFE for the period 2003–05. This decline is not statisticallysignificant. Neither does it appear that there is anupwards trend, which is consistent with the findings of thelatest morbidity study from the United Kingdom ObstetricSurveillance System (UKOSS) (A detailed description of UKObstetric Surveillance System (UKOSS) can be found in theIntroduction Chapter of this Report.) discussed below.Maternal morbidity: the incidence of amnioticfluid embolismProspective national surveillance of AFE has been undertakenthrough UKOSS since 2005. A recent analysis of casesreported over 4 years between February 2005 and February2009 documented an incidence of 2.0 cases per 100 000Table 5.1. Direct deaths attributed to amniotic fluid embolism andrates per 100 000 maternities; UK: 1985–2008Triennium n Rate 95% CI1985–87 9 0.40 0.21–0.751987–90 11 0.47 0.26–0.831991–93 10 0.43 0.23–0.801994–96 17 0.77 0.48–1.241997–99 8 0.38 0.19–0.742000–02 5 0.25 0.11–0.592003–05 17 0.80 0.50–1.292006–08 13 0.57 0.33–0.98ª 2011 Centre for Maternal and Child Enquiries (CMACE), BJOG 118 (Suppl. 1), 1–203 77