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Anesthesiology 2019 Feb 11. Epub 2019 Feb 11.

From the Department of Anesthesiology, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina.

Nurs Womens Health 2019 Feb;23(1):38-48

Anaphylactoid syndrome of pregnancy (ASP) is a widespread, proinflammatory, anaphylactic-like reaction that can occur when amniotic fluid enters the maternal blood circulation. ASP is characterized by four cardinal findings: respiratory distress, altered mental status, hypotension, and disseminated intravascular coagulation. ASP is commonly associated with maternal and neonatal mortality. Read More

Case Rep Womens Health 2019 Jan 23;21:e00097. Epub 2019 Jan 23.

University of South Alabama, Children's and Women's Hospital, Department of Obstetrics and Gynecology, 251 Cox Street, Mobile, AL 36604, United States.

Cerebrovascular disease is not uncommon during pregnancy as a result of either venous or arterial occlusion, or a hemorrhagic event, resulting in ischemia. Pregnancy may alter the prognosis of these neurologic disorders, with increased risks of morbidity and mortality for the mother and the developing fetus. Etiologies of stroke during pregnancy and the postpartum period include preeclampsia, eclampsia, HELLP syndrome, posterior reversible encephalopathy syndrome (PRES), amniotic fluid embolism, postpartum angiopathy, postpartum cardiomyopathy, thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), cerebral venous thrombosis, CNS infections, and maternal thrombophilia. Read More

Case Rep Oncol 2018 Sep-Dec;11(3):822-834. Epub 2018 Dec 11.

University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands.

Among the differential diagnoses that should be considered in acute respiratory failure (ARF) are infectious processes, autoimmune diseases, interstitial pulmonary fibrosis, and pulmonary neoplasia. Timely diagnosis of lung neoplasia is complicated in the early stages. An opportune diagnosis, as well as the specific treatment, decrease mortality. Read More

J Clin Anesth 2019 Jan 17;56:4-5. Epub 2019 Jan 17.

Department of Obstetrics, Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, China. Electronic address:

J Matern Fetal Neonatal Med 2019 Jan 22:1-6. Epub 2019 Jan 22.

a Russian Ministry of Health , Federal State Budget Educational Institution of Higher Education Omsk State Medical University , Omsk , Russia.

Aim: To assess the efficacy of a Zhukovsky obstetric double balloon for improving outcomes in women undergoing hysterectomy for postpartum hemorrhage.

Materials And Methods: This was a randomized controlled study. Participants were divided into two groups to undergo insertion of a Zhukovsky obstetric double balloon prior to hysterectomy (n = 16) or conventional hysterectomy (n = 25). Read More

Sud Med Ekspert 2018 ;61(6):48-51

Department of Forensic Medicine, S.M. Kirov Military Medical Academy, Ministry of Defense of the Russia, Saint-Petersburg, Russia, 194044.

The authors report two cases of extended amniotic fluid embolism (AFE) associated with the birth-giving process with the analysis of their causes and the discussion of the possible pathways through which the amniotic fluid penetrates into maternal blood. A rare cause of amniotic fluid embolism due to the rupture of placental membranes as a result of submembranous hemorrhage is described. The changes in the lungs associated with extended AFE are apparent in the presence of macroscopic emboli formed from the particles of the amniotic fluid. Read More

Am J Obstet Gynecol 2018 Nov 24. Epub 2018 Nov 24.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX.

PLoS One 2018 26;13(11):e0207920. Epub 2018 Nov 26.

Department of Information Management, Hunan Province Maternal and Children Health Care Hospital, Changsha, Hunan, China.

Background: The control of maternal deaths continues to be a significant public health issue and commands an enormous amount of attention, especially under the future family planning policy. Here, we describe the epidemiology and trends of maternal deaths in Hunan province, and give several policy implications.

Methods: Maternal deaths in Hunan province between 2009 and 2014 were retrospectively reviewed and analyzed. Read More

Fa Yi Xue Za Zhi 2018 Aug 25;34(4):384. Epub 2018 Aug 25.

School of Forensic Medicine, Kunming Medical University, Kunming 650500, China.

Objectives: To study the epidemiological and pathological features of sudden death （SD） in Yunnan Province and to provide scientific evidence for prevention and forensic identification of sudden death.

Methods: Totally 363 SD cases were collected from the autopsies between 2009 and 2017 in the Forensic Centre of Kunming Medical University. The related factors such as etiology, age, inducing factor, time interval between the onset of disease and death, morbidity season and pathological change were retrospectively analysed. Read More

J Matern Fetal Neonatal Med 2018 Nov 4:1-8. Epub 2018 Nov 4.

a Department of Forensic Science, School of Basic Medical Sciences , Central South University , Changsha , China.

Amniotic fluid embolism (AFE) and spontaneous hepatic rupture both are extremely rare complications of pregnancy that can be fatal to mother and/or child. AFE is characterized by a sudden collapse of the cardiovascular system, a change in mental status, and disseminated intravascular coagulation (DIC), occurring immediately during labor, delivery, or postpartum, caused by the inflow of amniotic components into the maternal circulation. Spontaneous hepatic rupture during pregnancy which is most often occurs alongside hypertensive disorders, eclampsia, or HELLP syndrome. Read More

Br J Hosp Med (Lond) 2018 Oct;79(10):C157-C160

Consultant in Anaesthesia and Obstetric Lead, Department of Anaesthesia, Royal United Hospitals, Bath.

Int J Obstet Anesth 2018 Sep 11. Epub 2018 Sep 11.

Department of Medicine, Royal Gwent Hospital, Newport, United Kingdom.

Amniotic fluid embolism is a rare but often catastrophic emergency. The non-specific clinical features and lack of diagnostic tests make it a diagnosis of exclusion. Point-of-care visco-elastometric testing is being increasingly used during obstetric haemorrhage. Read More

J Obstet Gynaecol Res 2019 Jan 24;45(1):239. Epub 2018 Sep 24.

Department of Anesthesiology, Texas A&M College of Medicine, Temple, Texas, USA.

Indian J Anaesth 2018 Sep;62(9):704-709

Department of Anaesthesia, ESICMC-PGIMSR, Bengaluru, Karnataka, India.

Obstetric emergencies are a challenge both for the obstetrician and the anaesthesiologist. The incidence of caesarean sections as per the National Family Health Survey published in 2015-16 was 17.2%. Read More

Rev Esp Cardiol (Engl Ed) 2018 Sep 14. Epub 2018 Sep 14.

Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain.

AACN Adv Crit Care 2018 ;29(3):336-342

Anne-Marie McBride is Clinical Nurse, Intensive Care, Calvary North Adelaide Hospital, 23 Strangways Terrace, North Adelaide, 5006 Australia

Obstetric emergencies often require intensive care intervention. Amniotic fluid embolism is a rare, unpredictable, and often catastrophic complication of pregnancy that is suspected in a woman who experiences cardiac arrest after a cesarean section. The condition occurs in approximately 1 in 40 000 births and has an average case-fatality rate of 16%. Read More

Clin Chest Med 2018 Sep;39(3):505-513

Pulmonary and Critical Care Medicine, Geisinger, 100 North Academy Avenue, Danville, PA 17822-1334, USA.

Pulmonary artery filling defects can be observed in various pathologic processes other than pulmonary embolism, for example, nonthrombotic pulmonary embolism with biological and nonbiological materials and intrinsic pulmonary artery lesions. They have also been described in rare conditions, such as fibrosing mediastinitis and congenital absence or stenosis of pulmonary artery, and some pulmonary parenchymal and airway malignancies. Misdiagnosis is common owing to the relative rarity of these conditions. Read More

J Obstet Gynaecol Res 2018 Oct 5;44(10):1995-1998. Epub 2018 Jul 5.

Department of Obstetrics and Gynecology, Japanese Red Cross Ise Hospital, Ise, Japan.

Amniotic fluid embolism (AFE) causes consumption coagulopathy, which requires a massive transfusion to save the mother's life. The preparation of such a massive transfusion is too time-consuming in extremely emergent clinical settings and occasionally leads to devastating side effects such as transfusion-associated acute lung injury. C1 esterase inhibitor (C1INH) is a protein with the ability to inhibit complement, coagulation and kinin pathways. Read More

Z Geburtshilfe Neonatol 2018 Aug 25;222(4):143-151. Epub 2018 Jun 25.

Department of Obstetrics and Gynecology, Alexandroupolis, Democritus University of Thrace, Greece.

According to data from the WHO, maternal mortality ratio has dropped worldwide by 44% between 1990 and 2015, yet more than 300,000 mothers still die annually, about 99% of them in the developing countries. In some developed countries the incidence of maternal deaths has even increased during the past 2 decades. The leading causes of direct maternal deaths are haemorrhage (nearly 3-quarters from postpartum haemorrhage), pulmonary embolism including amniotic fluid embolism, and hypertensive disorders of pregnancy; the leading cause of indirect maternal deaths is cardiac disease of the mother. Read More

Korean J Intern Med 2019 Jan 25;34(1):227-230. Epub 2018 Jun 25.

Surgical Oncology Unit, Department of Oncology and Advanced Technologies, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.

J Obstet Gynaecol India 2018 Jun 26;68(3):155-163. Epub 2018 Mar 26.

2Department of Anaesthesiology, Pain & Critical Care, AFMC, Pune, India.

Maternal mortality is disastrous news for the society, family, newborn, and the obstetrician. Yet, we all who are care providers to these apparently healthy women carrying another life within them are dumbfounded by the clinical conditions arising due to the pregnancy or the effects of the pregnancy, that it becomes difficult to provide an ideal care to them. The rapid uprising of a condition and the worsening of commonly occurring benign conditions-preeclampsia, hemorrhage, etc. Read More

J Turk Ger Gynecol Assoc 2018 11 8;19(4):210-214. Epub 2018 Jun 8.

General Directorate of Mother and Child Health and Family Planning, Ministry of Health of Turkey, Ankara, Turkey

Objective: To analyze the value of autopsy reports for determining the cause of maternal deaths in Turkey.

Material And Methods: In this descriptive retrospective study, the case files of 992 maternal deaths, except for accidental causes, that occurred in Turkey between 2012 and 2016 were reviewed. An autopsy examination was performed in 177 (17. Read More

J Coll Physicians Surg Pak 2018 Jun;28(6):S107-S109

Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi.

Amniotic fluid embolism is a rare and severe problem in obstetric patients. We experienced a 21-year primigravida who underwent emergency cesarean section due to sudden collapse and fetal distress after rupture of membranes in labour. Subsequently, she developed intraoperative coagulopathy, hemorrhage, hypotension, and respiratory collapse requiring ventilation. Read More

J Thorac Dis 2018 Mar;10(3):E189-E193

Department of Forensic Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.

Amniotic fluid embolism (AFE) is a rare but fatal obstetric emergency, which is characterized by a sudden cardiovascular collapse, respiratory failure, and disseminated intravascular coagulation (DIC). We report a case of sudden cardiac arrest due to an amniotic-fluid embolism which was successfully treated with veno-arterial extracorporeal membrane oxygenation (ECMO). A 32-year-old female at 39. Read More

Masui 2017 May;66(5):546-549

We report a case of sudden shock during caesarean section under combined spinal epidural anesthesia. The patient was a 29-year-old woman. During the operation vital signs had been almost stable until a female-baby was born. Read More

Taiwan J Obstet Gynecol 2018 Apr;57(2):276-282

Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou 450052, China.

Objective: We aimed to evaluate our experience with the application of uterine wall local resection and reconstruction to preserve the uterus in patients with morbidly adherent placenta.

Materials And Methods: In a retrospective study, data from patients with morbidly adherent placenta who delivered by cesarean section between January 1, 2013 and May 31, 2016 were analyzed. Prophylactic abdominal aorta balloon occlusion and tourniquet were used to prevent massive hemorrhage in all 62 cases, followed by uterine wall local resection and reconstruction to preserve the uterus. Read More

J Nephrol 2018 Oct 10;31(5):645-651. Epub 2018 Apr 10.

APHP, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, 4 rue de la Chine, 75020, Paris, France.

Kidneys may fail post-partum in a number of circumstances due, for example, to post-partum haemorrhage, preeclampsia, amniotic fluid embolism or septic abortion. All these conditions in pregnancy and post partum represent a threat not only to the endothelium but also to the renal tubular epithelium, and as such may lead to rapid and also irreversible impairment of the renal function. This paper is a non-systematic review of the literature and of our experience, in which we discuss the main open issues on kidney disease in pregnancy and following delivery, in particular as regards tubular damage, with the aim to help reasoning on acute kidney injury (AKI) following delivery. Read More

Obstet Gynecol Sci 2018 Mar 8;61(2):209-219. Epub 2018 Feb 8.

Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Objective: Reviewing indications and characteristics of obstetric patients admitted to the intensive care unit (ICU) of a tertiary care center, comparing those patients by time period and place of delivery, and to verify clinical utility of acute physiology and chronic health evaluation (APACHE) II score in ICU-admitted women.

Methods: Retrospective analyses were carried out for parturients admitted to the ICU of our institution from 1994 to 2015. Clinical characteristics were compared between time period (period 1: 1994-2004; period 2: 2005-2015) and place of delivery (our institution and local hospitals). Read More

Am J Perinatol 2019 Jan 8;36(1):8-14. Epub 2018 Feb 8.

Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.

Objective:  To determine the factors associated with severe maternal morbidity in a modern cohort of women laboring at term and to create a prediction model.

Study Design:  This is a retrospective cohort study of all term, laboring patients with live births at a single tertiary care center from 2004 to 2014. The primary outcome was composite maternal morbidity including organ failure, amniotic fluid embolism, anesthesia complications, sepsis, shock, thrombotic events, transfusion, or hysterectomy. Read More

J Coll Physicians Surg Pak 2018 Mar;28(3):S49-S50

Department of Urogynecology, The Aga Khan University Hospital, Karachi.

The management of puerperal hematomas after normal delivery has always been challenging for obstetricians. Vulvar, vulvovaginal, or paravaginal hematomas are common. On the other hand, retroperitoneal hematomas are uncommon and can be life-threatening. Read More

Case Rep Obstet Gynecol 2017 21;2017:8458375. Epub 2017 Dec 21.

Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, 234 East 149th Street, Bronx, NY 10451, USA.

Amniotic fluid embolism (AFE) is the second leading cause of maternal mortality in the USA with an incidence of 1 : 15,200 births. The case fatality rate and perinatal mortality associated with AFE are 13-30% and 9-44%, respectively. This rare but devastating complication can be difficult to diagnose as many of the early signs and symptoms are nonspecific. Read More

Health Technol Assess 2018 01;22(2):1-88

Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Background: Caesarean section is associated with blood loss and maternal morbidity. Excessive blood loss requires transfusion of donor (allogeneic) blood, which is a finite resource. Cell salvage returns blood lost during surgery to the mother. Read More

Am J Obstet Gynecol 2018 04 29;218(4):460-461. Epub 2017 Dec 29.

Departments of Obstetrics and Gynecology and Pathology, Baylor College of Medicine and Ben Taub Hospital, 6651 Main Street, Suite F1096, Houston, TX 77030. Electronic address:

PLoS Med 2017 Dec 19;14(12):e1002471. Epub 2017 Dec 19.

Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.

Background: Excessive haemorrhage at cesarean section requires donor (allogeneic) blood transfusion. Cell salvage may reduce this requirement.

Methods And Findings: We conducted a pragmatic randomised controlled trial (at 26 obstetric units; participants recruited from 4 June 2013 to 17 April 2016) of routine cell salvage use (intervention) versus current standard of care without routine salvage use (control) in cesarean section among women at risk of haemorrhage. Read More

Asian J Anesthesiol 2017 Dec 9;55(4):93-94. Epub 2017 Dec 9.

Department of Anesthesiology, Changhua Christian Hospital, Taiwan.

J Matern Fetal Neonatal Med 2017 Dec 11. Epub 2017 Dec 11.

Int J Obstet Anesth 2018 02 21;33:99-100. Epub 2017 Oct 21.

Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse III Paul Sabatier, France. Electronic address:

Hemoglobin 2017 Jul - Nov;41(4-6):225-229. Epub 2017 Nov 28.

a Cardeza Foundation for Hematologic Research, Department of Medicine , Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA.

As outcomes of patients with sickle cell anemia improve and survival into adulthood with good quality of life and expectation of long-term survival becomes more common, challenges have developed, including issues related to reproduction. Pregnancy is frequently complicated in patients with sickle cell anemia with mortality up to 4.0%. Read More

Gynecol Obstet Fertil Senol 2017 Dec 21;45(12S):S31-S37. Epub 2017 Nov 21.

Gynécologie-obstétrique et médecine de la reproduction, université Caen, UFR médecine, CHU de Caen, avenue de la Côte-de-Nacre, 14003 Caen, France.

Pregnancy and postpartum are very high-risk periods for venous thromboembolism events (TEE), which seems to extend far beyond the classical 6-8 weeks after childbirth. Pulmonary embolism (PE) is one of the 3 main causes of direct maternal death in western countries. Between 2010 an 2012 in France, 24 deaths were related to PE giving a maternal mortality ratio of 1/100,000, which is not different from the former report (2007-2009). Read More

J Matern Fetal Neonatal Med 2019 Apr 22;32(8):1262-1266. Epub 2017 Nov 22.

a Department of Anesthesia, and Sackler Faculty of Medicine , Rabin Medical Center, Beilinson Hospital, Petach Tikvah Israel, Tel Aviv University , Tel Aviv , Israel.

Introduction: Amniotic fluid embolism (AFE) is a rare and potentially lethal obstetric complication, commonly occurring during labor, delivery, or immediately postpartum. There is a paucity of data regarding incidence, risk factors, and clinical management. Our primary objective in this study was to evaluate clinical presentation of AFE and delineate anesthesia management of these cases. Read More

Gynecol Obstet Fertil Senol 2017 Dec 14;45(12S):S43-S47. Epub 2017 Nov 14.

Maternité, hôpital privé de Villeneuve d'Ascq, Quartier du Recueil, 20, avenue de La Reconnaissance, 59491 Villeneuve-d'Ascq, France.

Amniotic fluid embolism (AFE) is an unpredictable, dreadful complication of pregnancy or childbirth. EA typically includes in the same lapse of time respiratory, haemodynamic, neurological and hemorrhagic symptoms (from early and severe coagulopathy). Immediate supportive treatment by a multidisciplinary team is the cornerstone of the management. Read More

JAMA 2017 11;318(18):1777-1786

Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada.

Importance: Although high body mass index (BMI) is associated with adverse birth outcomes, the association with severe maternal morbidity is unclear.

Objective: To examine the association between prepregnancy BMI and severe maternal morbidity.

Design, Setting, And Participants: Retrospective population-based cohort study including all singleton hospital births in Washington State, 2004-2013. Read More

Blood Transfus 2018 Nov 29;16(6):498-501. Epub 2017 Sep 29.

Department of Anesthesiology, Magee-Women's Hospital of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.

Background: The safety and effectiveness of cell salvage for vaginal delivery is unknown. This case series aimed to assess the utility and adverse events related to the use of cell salvage for maternal haemorrhage during vaginal delivery.

Materials And Methods: A cohort study design was chosen, focused on postpartum haemorrhages that occurred after vaginal delivery for which cell salvage equipment was requested to be set up in the labour and delivery room outside of a sterile operating room environment. Read More

Clin Case Rep 2017 10 2;5(10):1668-1671. Epub 2017 Sep 2.

Department of Obstetrics Hokkaido University Graduate School of Medicine Sapporo Japan.

There have been no reports regarding imaging-documented bronchospasm in patients with amniotic fluid embolism (AFE). In a woman with scheduled cesarean section for placenta previa, transient bronchospasm and pulmonary hypertension were documented explaining a sudden drop in SpO. Mild AFE was the most likely diagnosis in this patient. Read More

Acta Anaesthesiol Scand 2018 01 5;62(1):134-137. Epub 2017 Oct 5.

Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark.

Anesth Analg 2018 01;126(1):175-182

From the Inserm UMR 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.

Background: A structured definition of amniotic fluid embolism (AFE) based on 4 criteria was recently proposed for use in research by the Society for Maternal-Fetal Medicine (SMFM) and the Amniotic Fluid Embolism Foundation. The main objective of this study was to review all AFE-related maternal deaths in France during 2007-2011 according to the presence or not of all these 4 diagnostic criteria.

Methods: Maternal deaths due to AFE were identified by the national experts committee of the French Confidential Enquiry into Maternal Deaths during 2007-2011 (n = 39). Read More

J Clin Diagn Res 2017 Jul 1;11(7):QC18-QC21. Epub 2017 Jul 1.

Department of Obstetrics and Gynaecology, Nara Medical University, Nara, Japan.

Introduction: There are several sets of criteria for the diagnosis of Amniotic Fluid Embolism (AFE), but little is known about their degree of agreement.

Aim: To evaluate the concordance of the Japan criteria for AFE in comparison with two definitions: the US AFE registration entry criteria (the US criteria) and UK Obstetric Surveillance System criteria for defining cases of amniotic fluid embolism (the UK criteria).

Materials And Methods: A retrospective observational study was conducted in which the AFE cases registered in the Obstetrical Gynaecological Society of Kinki District in Japan for the period of April 2005 to December 2012 have been analysed by the expert steering obstetric committee, organized by the members of the Obstetric Research group. Read More

J Obstet Gynaecol Res 2017 Dec 11;43(12):1815-1820. Epub 2017 Sep 11.

Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan.

Aim: We aimed to evaluate the clinical usefulness of serum squamous cell carcinoma (SCC) antigen for the diagnosis of amniotic fluid embolism (AFE).

Methods: Sera and information of 20 patients with AFE (autopsy-proven AFE, four cases; clinical AFE, 16 cases) were obtained from the Japan Amniotic Fluid Embolism Registration Center at Hamamatsu University School of Medicine. As controls, we included 74 gestational-age-matched healthy women who gave birth to healthy newborns during the period from December 2012 to January 2014. Read More

J Obstet Gynaecol Res 2017 Nov 17;43(11):1714-1718. Epub 2017 Aug 17.

Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

Aim: The objective of this study was to determine the mortality rate of amniotic fluid embolism (AFE) using population-based studies and case series.

Methods: A literature search was conducted using the two key words: 'amniotic fluid embolism (AFE)' AND 'mortality rate'. Thirteen population-based studies were evaluated, as well as 36 case series including at least two patients. Read More