Amniotic pulmonary embolism and the respiratory system: Management trends and future options

摘要

Amniotic fluid embolism (AFE) is a rare and catastrophic clinical syndrome that occurs at childbirth and the postpartum period, and that significantly affects the respiratory system. In developed countries, AFE causes up to 10% of all maternal deaths [1]. Most of these patients will have acute hypoxemic respiratory failure and a decrease compliance of the respiratory system. The incidence of AFE in the United States is thought to be about 1 in 13,000 deliveries, with a high mortality rate [2]. AFE was initially described by Meyer in 1926, but it was not until 1941, when Steiner and Lushbaugh attributed maternal death to this syndrome [3]. The risk factors commonly seen in AFE include: advanced maternal age, cesarean section, induction of labor, placental abnormalities, pre-eclampsia, eclampsia, multiple pregnancy, and uterine rupture [4-6]. The most common manifestations occurring in up to 40% of patients with AFE include: acute onset of dyspnea, severe clinical hypotension, dysrrhythmias, life-threatening hemorrhage, fetal distress and cardiac arrest [3].