Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies

Steven L. Clark, Roberto Romero, Gary A. Dildy, William M. Callaghan, Richard M. Smiley, Arthur W. Bracey, Gary D. Hankins, Mary E. D'Alton, Mike Foley, Luis D. Pacheco, Rakesh B. Vadhera, J. Patrick Herlihy, Richard L. Berkowitz, Michael A. Belfort

Research output: Contribution to journalArticle

39 Scopus citations

Abstract

Amniotic fluid embolism is a leading cause of maternal mortality in developed countries. Our understanding of risk factors, diagnosis, treatment, and prognosis is hampered by a lack of uniform clinical case definition; neither histologic nor laboratory findings have been identified unique to this condition. Amniotic fluid embolism is often overdiagnosed in critically ill peripartum women, particularly when an element of coagulopathy is involved. Previously proposed case definitions for amniotic fluid embolism are nonspecific, and when viewed through the eyes of individuals with experience in critical care obstetrics, would include women with a number of medical conditions much more common than amniotic fluid embolism. We convened a working group under the auspices of a committee of the Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation whose task was to develop uniform diagnostic criteria for the research reporting of amniotic fluid embolism. These criteria rely on the presence of the classic triad of hemodynamic and respiratory compromise accompanied by strictly defined disseminated intravascular coagulopathy. It is anticipated that limiting research reports involving amniotic fluid embolism to women who meet these criteria will enhance the validity of published data and assist in the identification of risk factors, effective treatments, and possibly useful biomarkers for this condition. A registry has been established in conjunction with the Perinatal Research Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development to collect both clinical information and laboratory specimens of women with suspected amniotic fluid embolism in the hopes of identifying unique biomarkers of this condition.

Original languageEnglish (US)
Pages (from-to)408-412
Number of pages5
JournalAmerican journal of obstetrics and gynecology
Volume215
Issue number4
DOIs
StatePublished - Oct 1 2016

Keywords

  • amniotic fluid embolism
  • critical care

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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    Clark, S. L., Romero, R., Dildy, G. A., Callaghan, W. M., Smiley, R. M., Bracey, A. W., Hankins, G. D., D'Alton, M. E., Foley, M., Pacheco, L. D., Vadhera, R. B., Herlihy, J. P., Berkowitz, R. L., & Belfort, M. A. (2016). Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. American journal of obstetrics and gynecology, 215(4), 408-412. https://doi.org/10.1016/j.ajog.2016.06.037