Given that AFE is considered the least preventable cause of maternal mortality, 5 there may be additional medical legal pressure to diagnose AFE in some cases of maternal mortality. The need to rely on clinical criteria has likely resulted in both over- and underdiagnosis, with underdiagnosis of mild cases as well as inappropriate diagnosis of AFE in women who become critically ill from other causes. AFE is a clinical diagnosis based on cardiorespiratory collapse and coagulopathy in the absence of other conditions sufficient to explain these symptoms: there are no serum or histologic findings specific to AFE. The historical lack of consistent criteria for diagnosing AFE has made it challenging to define the true incidence of the syndrome and has hampered efforts to evaluate treatment strategies. Given the critical need for timely and focused intervention for AFE, the development of facility-specific cognitive aids is recommended to assist in initial management. The goal of this article is to review the presentation, differential, and initial management of AFE as well as to discuss potential avenues to further our understanding and management of this rare, but potentially fatal syndrome. Despite being recognized as a syndrome for nearly 100 years, the etiology of AFE remains elusive, the diagnosis remains clinical, and management is entirely supportive.
#AMNIOTIC FLUID EMBOLISM MOST COMMON SITES PROFESSIONAL#
Women who die of AFE are less likely than those who survive to have an obstetrician or anesthesia professional present at the time of AFE, 2 highlighting the critical role for early recognition.
3 Early recognition and goal-directed treatment of suspected AFE is critical to successful management and decreasing morbidity. 1,2 AFE is the second leading cause of maternal death on the day of delivery in the United States. 1 While AFE is rare, with an incidence of 1–2/100,000 pregnancies, it is associated with a mortality or permanent neurologic injury rate of 30–40%.
Amniotic fluid embolism (AFE) is a catastrophic complication unique to the obstetric patient characterized by acute cardiovascular collapse and a profound coagulopathy.
0 kommentar(er)
