Incidence and risk factors for amniotic-fluid embolism.
OBJECTIVE: To estimate the incidence of amniotic-fluid embolism and to describe risk factors, management, and outcomes. METHODS: Through a population-based cohort study and nested case-control analysis, using the UK Obstetric Surveillance System, we identified 60 women in the United Kingdom who had...
| Main Authors: | , , , , |
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| Format: | Journal article |
| Language: | English |
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2010
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| _version_ | 1797084991784484864 |
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| author | Knight, M Tuffnell, D Brocklehurst, P Spark, P Kurinczuk, J |
| author_facet | Knight, M Tuffnell, D Brocklehurst, P Spark, P Kurinczuk, J |
| author_sort | Knight, M |
| collection | OXFORD |
| description | OBJECTIVE: To estimate the incidence of amniotic-fluid embolism and to describe risk factors, management, and outcomes. METHODS: Through a population-based cohort study and nested case-control analysis, using the UK Obstetric Surveillance System, we identified 60 women in the United Kingdom who had an amniotic-fluid embolism between February 2005 and February 2009 and 1,227 women for the control group. We investigated the potential factors underlying amniotic-fluid embolism using an exploratory logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Sixty cases of amniotic-fluid embolism were reported, an estimated incidence of 2.0 per 100,000 deliveries (95% CI 1.5-2.5). Amniotic-fluid embolism occurrence was significantly associated with induction of labor (adjusted OR 3.86, 95% CI 2.04-7.31) and multiple pregnancy (adjusted OR 10.9, 95% CI 2.81-42.7); an increased risk also was noted in older, ethnic-minority women (adjusted OR 9.85, 95% CI 3.57-27.2). Cesarean delivery was associated with postnatal amniotic-fluid embolism (adjusted OR 8.84, 95% CI 3.70-21.1). Twelve women died (case fatality 20%, 95% CI 11-32%); 5 of 37 newborns of women with antenatal amniotic-fluid embolism died (perinatal mortality 135 per 1,000 total births, 95% CI 45-288). Women who died were significantly more likely to be from ethnic-minority groups (adjusted OR 11.8, 95% CI 1.40-99.5). CONCLUSION: High-quality supportive care can result in good maternal outcomes after amniotic-fluid embolism. Clinicians should consider both the risks and benefits of induction and cesarean delivery because more restricted use may result in a decrease in the number of women suffering a potentially fatal amniotic-fluid embolism. The observed increased risk of fatality in ethnic-minority women may be associated with differences in underlying medical conditions or access to care, and clinicians should that ensure appropriate services are provided to minimize this risk. |
| first_indexed | 2024-03-07T02:02:53Z |
| format | Journal article |
| id | oxford-uuid:9df70908-4190-4068-997d-30a86106d4bd |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:02:53Z |
| publishDate | 2010 |
| record_format | dspace |
| spelling | oxford-uuid:9df70908-4190-4068-997d-30a86106d4bd2022-03-27T00:46:53ZIncidence and risk factors for amniotic-fluid embolism.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:9df70908-4190-4068-997d-30a86106d4bdEnglishSymplectic Elements at Oxford2010Knight, MTuffnell, DBrocklehurst, PSpark, PKurinczuk, J OBJECTIVE: To estimate the incidence of amniotic-fluid embolism and to describe risk factors, management, and outcomes. METHODS: Through a population-based cohort study and nested case-control analysis, using the UK Obstetric Surveillance System, we identified 60 women in the United Kingdom who had an amniotic-fluid embolism between February 2005 and February 2009 and 1,227 women for the control group. We investigated the potential factors underlying amniotic-fluid embolism using an exploratory logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Sixty cases of amniotic-fluid embolism were reported, an estimated incidence of 2.0 per 100,000 deliveries (95% CI 1.5-2.5). Amniotic-fluid embolism occurrence was significantly associated with induction of labor (adjusted OR 3.86, 95% CI 2.04-7.31) and multiple pregnancy (adjusted OR 10.9, 95% CI 2.81-42.7); an increased risk also was noted in older, ethnic-minority women (adjusted OR 9.85, 95% CI 3.57-27.2). Cesarean delivery was associated with postnatal amniotic-fluid embolism (adjusted OR 8.84, 95% CI 3.70-21.1). Twelve women died (case fatality 20%, 95% CI 11-32%); 5 of 37 newborns of women with antenatal amniotic-fluid embolism died (perinatal mortality 135 per 1,000 total births, 95% CI 45-288). Women who died were significantly more likely to be from ethnic-minority groups (adjusted OR 11.8, 95% CI 1.40-99.5). CONCLUSION: High-quality supportive care can result in good maternal outcomes after amniotic-fluid embolism. Clinicians should consider both the risks and benefits of induction and cesarean delivery because more restricted use may result in a decrease in the number of women suffering a potentially fatal amniotic-fluid embolism. The observed increased risk of fatality in ethnic-minority women may be associated with differences in underlying medical conditions or access to care, and clinicians should that ensure appropriate services are provided to minimize this risk. |
| spellingShingle | Knight, M Tuffnell, D Brocklehurst, P Spark, P Kurinczuk, J Incidence and risk factors for amniotic-fluid embolism. |
| title | Incidence and risk factors for amniotic-fluid embolism. |
| title_full | Incidence and risk factors for amniotic-fluid embolism. |
| title_fullStr | Incidence and risk factors for amniotic-fluid embolism. |
| title_full_unstemmed | Incidence and risk factors for amniotic-fluid embolism. |
| title_short | Incidence and risk factors for amniotic-fluid embolism. |
| title_sort | incidence and risk factors for amniotic fluid embolism |
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