Profile and Outcomes of Women With Amniotic Fluid Embolism in the United States [ID: 1375935]

INTRODUCTION: Amniotic fluid embolism (AFE) is one of the most catastrophic pregnancy complications and a significant cause of maternal mortality in the United States. The estimated incidence of AFE is 1:15,200 in North America. However, unanswered questions remain about its etiology, risk factors, perinatal morbidity, mortality, and treatment options. In the present study, we described the profile and outcomes of women who develop AFEs in the United States. METHODS: We collated data from the National Inpatient Sample Database from January 2010 to December 2017 to conduct a retrospective analysis of women who developed AFEs. We conducted a multivariate analysis to determine the risk of the development of AFE and the outcomes after its development. We included covariates such as women’s age, race and ethnicity, preexisting comorbidities, pregnancy-associated risk factors, and region of the country in the multivariate analysis. Samples were weighed to generate nationally representative estimates. RESULTS: There were 1,659 cases of AFE in the NIS during the study period. The median age of these women was 31 years (interquartile range of 26–36 years). 57.8% of the women underwent cesarean section, 48.2% developed disseminated intravascular coagulation, and 37.0% developed acute respiratory distress syndrome. The overall mortality rate was 12.9%. On univariate analysis, women between the ages of 31 and 40 years have a twofold incidence of developing AFE (odds ratio [OR] 2.51, 95% CI 1.45–4.35), while women between 41 and 50 years have a lower risk (OR 0.41, 95% CI 0.19–0.88) compared to the reference (women ≤20 years). Other risk factors include electrolyte abnormalities (OR 5.23, 95% CI 3.72–7.35) and cesarean section (OR 8.2, 95% CI 6.35–10.61). On multivariate analysis, only cesarean section and electrolyte abnormalities have a statistically significant association with the development of AFE. CONCLUSION: Amniotic fluid embolism remains a rare but catastrophic emergency with high morbidity and mortality in the United States.