6, 11, 12 Recent evidence also suggests at least one-fifth of all cases of AFE were most likely incorrectly diagnosed (possible overdiagnosis), underscoring the diagnostic challenges surrounding AFE. 2, 4, 5, 6, 7, 8, 9, 10 These wide ranges are likely attributable to the lack of uniform diagnostic criteria. 1, 2, 3 The reported incidence ranges from 0.8 to 7.7 per 100 000 births, with similarly wide reports of case mortality ranging from 11% to 43%. 1 Amniotic fluid embolism (AFE), despite its rarity, is a leading cause of maternal mortality that often presents as sudden cardiovascular collapse, respiratory distress, and coagulopathy. Maternal mortality has more than doubled during the past 3 decades in the US, with most recent national estimates of 17.3 maternal deaths per 100 000 live births in 2017. The failure-to-rescue rate after AFE also exceeded 30% when AFE occurred in the setting of placental pathology: 42.9% for AFE and PAS and 31.3% for AFE and placental abruption. However, the failure-to-rescue rate exceeded 30% when AFE co-occurred with other severe maternal morbidity indicators: 45.8% for AFE, cardiac arrest, and coagulopathy 43.2% for AFE, shock, and cardiac rhythm conversion and 38.6% for AFE, cardiac arrest, coagulopathy, and shock. The failure-to-rescue rate after AFE was 17.0% overall. When stratified by the PAS subtypes, more severe forms of PAS had a greater association with AFE (aOR for increta and percreta, 17.35 95% CI, 10.21-28.48 and aOR for accreta, 7.62 95% CI, 4.83-12.01). Among these characteristics, PAS had the largest association with AFE (adjusted odds ratio, 10.01 95% CI, 7.03-14.24). In a multivariable analysis, (1) patient factors of older age, Asian and Black race, Western US region, pregestational hypertension, asthma, illicit substance use, and grand multiparity (2) pregnancy factors of placental accreta spectrum (PAS), placental abruption, uterine rupture, polyhydramnios, chorioamnionitis, preeclampsia, fetal growth restriction, and fetal demise and (3) delivery factors of early gestational age, cervical ripening, cesarean delivery, operative delivery, and manual removal were associated with AFE. ![]() The cohort-level median patient age was 29 years (IQR, 25-33 years). Meeting Presentation: This study was presented at the 64th Kongress der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe OctoMünchen, Germany.Ī total of 14 684 135 deliveries were examined, with AFE diagnosed in 880 women, corresponding to an incidence rate of 6.0 per 100 000 deliveries. ![]() The program has not verified and is not responsible for the statistical validity of the data analysis or the conclusions derived by the study team. Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study collection, management, analysis, and interpretation of the data preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.ĭisclaimer: The National Inpatient Sample is developed for the Healthcare Cost and Utilization Project that is sponsored by the Agency for Healthcare Research and Quality. No other disclosures were reported.įunding/Support: This study was funded by an Ensign Endowment for Gynecologic Cancer Research (Dr Matsuo). Supervision: Youssefzadeh, Kunze, Mandelbaum, Matsuo.Ĭonflict of Interest Disclosures: Dr Klar reported receiving personal fees from Cooper Surgical and KLS Martin outside the submitted work. Statistical analysis: Klar, Mandelbaum, Matsuo.Īdministrative, technical, or material support: Ouzounian, Matsuo. Drs Mazza, Youssefzadeh, and Matsuo contributed equally to this work.Ĭoncept and design: Mazza, Youssefzadeh, Klar, Matsuzaki, Mandelbaum, Ouzounian, Matsuo.Īcquisition, analysis, or interpretation of data: Mazza, Klar, Kunze, Mandelbaum, Matsuo.ĭrafting of the manuscript: Mazza, Youssefzadeh, Klar, Matsuzaki, Mandelbaum, Matsuo.Ĭritical revision of the manuscript for important intellectual content: Mazza, Klar, Kunze, Mandelbaum, Ouzounian, Matsuo. Corresponding Author: Koji Matsuo, MD, PhD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Ave, IRD 520, Los Angeles, CA 90033 ( Contributions: Drs Mandelbaum and Matsuo had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
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