![]() First, the detection of acute-phase reactants in critically ill women believed to have had AFE limited value when the control group is composed of healthy pregnant women, rather than critically ill pregnant women with conditions other than AFE. 2 Many of these studies are difficult to interpret for 3 reasons. 2, 4- 7 In recent years, investigators have made attempts to identify serum markers for the diagnosis of AFE. Thus, reports based on histologic findings are biased. ![]() 4- 8 In addition, such reports, by definition, only included women who died and underwent autopsy, or were critically ill and required invasive hemodynamic monitoring, thus potentially eliminating less severely affected women and skewing both estimates of frequency and mortality. 2, 3 However, subsequent studies have documented that these findings are not specific to AFE. Many reports prior to the mid-1980s were based upon the detection of squamous cells and occasionally other debris of presumed fetal or placental origin in the maternal pulmonary circulation at autopsy or from a distal port aspirate of a pulmonary artery catheter. 2, 3 Scientific understanding of this condition, its pathophysiology, and its management have all been historically hampered by a lack of uniform diagnostic criteria. 2 Current concepts regarding pathophysiology and management of this condition have been summarized elsewhere. “Let us be careful not to make it (the diagnosis of amniotic fluid embolism) a waste-basket for all cases of unexplained death in labor.”Īmniotic fluid embolism (AFE) is an uncommon, but often fatal condition unique to obstetrics. ![]() A registry has been established in conjunction with the Perinatal Research Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development to collect both clinical information and laboratory specimens of women with suspected amniotic fluid embolism in the hopes of identifying unique biomarkers of this condition. It is anticipated that limiting research reports involving amniotic fluid embolism to women who meet these criteria will enhance the validity of published data and assist in the identification of risk factors, effective treatments, and possibly useful biomarkers for this condition. These criteria rely on the presence of the classic triad of hemodynamic and respiratory compromise accompanied by strictly defined disseminated intravascular coagulopathy. We convened a working group under the auspices of a committee of the Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation whose task was to develop uniform diagnostic criteria for the research reporting of amniotic fluid embolism. Previously proposed case definitions for amniotic fluid embolism are nonspecific, and when viewed through the eyes of individuals with experience in critical care obstetrics, would include women with a number of medical conditions much more common than amniotic fluid embolism. Amniotic fluid embolism is often overdiagnosed in critically ill peripartum women, particularly when an element of coagulopathy is involved. Our understanding of risk factors, diagnosis, treatment, and prognosis is hampered by a lack of uniform clinical case definition neither histologic nor laboratory findings have been identified unique to this condition. Amniotic fluid embolism is a leading cause of maternal mortality in developed countries. ![]()
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