Amniotic fluid embolism - Investigation of fatal cases in Slovakia in the years 2005-2010 compared with fatal cases in the United Kingdom

Abstract

Background. Amniotic fluid embolism (AFE) is a rare, often severe complication of pregnancy. The clinical diagnosis is difficult to establish and is one of exclusion. The aim of this study was to investigate 6 fatal cases of AFE in Slovakia and compare the incidence, risk factors, course, management and neonatal outcomes with fatal cases of AFE in the United Kingdom (UK). Materials and Methods. Data on fatal cases of AFE in Slovakia were analysed and compared with fatal cases in the UK in the years 2005-2010. Results. The incidence in Slovakia was significantly higher than in the UK from 2005-2010 (RR 5.03, 95% CI 1.98-12.75, P=0.003). However, 5/6 deaths occurred in 2009 coinciding with the H1N1 flu virus pandemic in Slovakia. There were no significant differences in the characteristics of women who died, with the exception of gestational age at delivery; significantly higher in Slovakia (median 41 versus 39 weeks, P=0.01). In Slovakia most of the cases occurred after delivery, 83.3%, compared with 52.9% in the UK. There were no significant differences in clinical signs, use of recombinant factor VIIa or performance of obstetric hysterectomy. In Slovakia 83.3% and in the UK 94.7% of infants survived, but 20% and 27.8% had some long-term sequelae. Conclusion. AFE is now the leading cause of maternal deaths in Slovakia. However, we found no significant differences in the possible risk factors, course, management or outcomes between Slovakia and the UK. This analysis is limited by study power; we propose that establishment of a national register of cases of AFE in Slovakia would help further investigate and monitor mortality from this condition.Key words: amniotic fluid embolism, incidence of amniotic fluid embolism, risk factors of amniotic fluid embolism, maternal mortality, neonatal outcome by amniotic fluid embolism

Analyses of severe acute maternal morbidity in Slovakia during years 2012–2016

“…SOSS was established in year 2012, after the close cooperation with the United Kingdom Obstetric Surveillance System (UKOSS -history started in 2005 year) due to "epidemy" of fatal amniotic fl uid embolism in the years 2009 and 2010 in Slovakia. This fi rst collaboration raised into a comparison of amniotic fl uid embolism cases and to comparison of perinatal outcomes between Slovakia and UK (5,6). Since 2012 SOSS work on active surveillance of SAMM in Slovakia and as a member of INOSS too (1,(7)(8)(9)(10)(11).…”