What is the prognosis of amniotic fluid embolism (AFE)?

Updated: May 13, 2019
  • Author: Lisa E Moore, MD, MS, FACOG, RDMS; Chief Editor: Carl V Smith, MD  more...
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Answer

Note the following:

  • Maternal mortality approaches 80%. However, it was 61% in the US national registry, which listed 46 cases.

  • Amniotic fluid embolism (AFE) is the cause of 5-10% of maternal mortality in the United States.

  • Of patients with AFE, 50% die within the first hour of onset of symptoms. Of survivors of the initial cardiorespiratory phase, 50% develop a coagulopathy.

  • A population-based study using the California Office of Statewide Planning and Development database reviewed 1,094,248 deliveries over a 2-year period. Of 53 cases of AFE, 14 patients (26.4%) died and 35 patients (66%) developed DIC. [19]

  • Maternal survival is uncommon, although the prognosis is improved with early recognition and prompt resuscitation. The United Kingdom AFE registry reported a mortality of 37%; of the women who survived AFE, 7% were neurologically impaired. [20]  

  • Neonatal survival has been reported to be 79% in the US registry and 78% in the UK registry. The intact infant survival rate is 70%. Neurologic status of the infant is directly related to the time elapsed between maternal arrest and delivery.

  • The risk of recurrence is unknown. Successful subsequent pregnancies have been reported. The recommendation for elective cesarean delivery during future pregnancies in an attempt to avoid labor is controversial.


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