Fatal factors of clinical manifestations and laboratory testing in patients with amniotic fluid embolism.

ABSTRACT

AIMS: To identify factors leading to fatality of patients with amniotic fluid embolism (AFE). METHODS: Patients who had fatal or nonfatal AFE were registered at the Hamamatsu University School of Medicine in the Department of Obstetrics and Gynecology from 1992 to 2006. Data collected included information about demographics and clinical characteristics. The fatal factors among these data were identified using chi(2) analysis and the Mann-Whitney test. RESULTS: One hundred and thirty-five patients met the criteria, which included fatal (n = 65) and nonfatal AFE (n = 70). Maternal full-term gestational weeks, multiparous and noncesarean sections were the risk factors for death found in this study (p < 0.01). Sialyl Tn levels (mean +/- SD) in the serum of patients with fatal AFE (69.7+/- 126.4 U/ml) were higher compared to those with nonfatal AFE (48.3+/- 161.8 U/ml; p = 0.003). Each of three items (cardiac arrest, dyspnea or loss of consciousness) was more common in fatal AFE (p < 0.01). Maternal pregnancy and labor complications were not associated with the distinction between fatal and nonfatal AFE. CONCLUSION: Factors associated with patients with fatal AFE were identified. These included multiparity, noncesarean section at full-term and the three symptoms mentioned above. Sialyl Tn levels could be a possible prognostic fatality factor.