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Amniotic fluid embolism rare but often fatal

NEW YORK (Reuters Health) – Although amniotic fluid embolism is rarely encountered, it has a high fatality rate, and a new study by Canadian researchers sheds light on the problem.

Dr. Michael S. Kramer, who led the study, told Reuters Health by email that given the serious consequences, “evidence that labor induction and cesarean delivery both increase the risk of amniotic fluid embolism is cause for concern.”

Dr. Kramer of McGill University in Montreal and colleagues examined hospital data on more than 4.5 million deliveries from 1991 to 2009, expanding on a study they published in 2006.

This time, as reported online April 24th in BJOG, they identified 292 cases of amniotic fluid embolism, but after further examination, confirmed only 120 — including 33 (27%) that were fatal. The incidence was 2.5 per 100,000 deliveries.

The condition was significantly associated older maternal age, grand multiparity, multiple birth, polyhydramnios, eclampsia, and pre-eclampsia.

Significant labor and delivery factors included premature rupture of membranes, medical induction, fetal distress, caesarean delivery, and instrumental vaginal delivery.

“Our updated and improved study confirmed our previously reported association of amniotic fluid embolism with medical induction of labor, as well as with all forms of operative delivery,” the investigators wrote.

To help prevent the problem, Dr. Kramer advises: “Don’t induce labor, don’t deliver by cesarean unless they are clinically indicated.”


BJOG 2012.