Factors related to maternal deaths induced by amniotic fluid embolism in county-level medical institutions
WU Ying-lan*, DU Yu-kai, GAO Jie
*Department of Child and Adolescent Health and Maternal and Child Healthcare, School of Public Health,Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
Abstract：Objective To investigate the factors influencing the maternal death cases resulting from amniotic fluid embolism in medical institutions at the county level in Hunan Province during 2011-2015, and to provide a basis for clinical diagnosis, prevention and effective treatment of amniotic fluid embolism in grass-roots medical institutions. Methods We retrospectively analyzed the data regarding 71 maternal deaths caused by amniotic fluid embolism in county level medical institutions in Hunan Province from 2011 to 2015. All the data about the 71 death cases were evaluated by the provicial expert group of maternal death assessment. The causes and influencing factors of the deaths were analyzed according to national uniform twelve tables of maternal death. Results Among the 71 cases of maternal dealth, 30-34 years old accounted for 29.58%, 35 years old and above 35.21%, primipara 32.69% and multipara 67.61%. 92.96% of the maternal deaths had rural household registration. The death cases with postpartum hemorrhage and acute symptoms (including cyanosis, sudden drop in blood pressure or breathing difficulties) as the main clinical manifestations accounted for 57.75% and 32.39% respectively. The death cases without typical symptoms and with deductive causes of death accounted for 9.86%. There were 11 (15.49%) cases of death occurring within 1 hour of illness onset, 44 (61.97%) cases of death occurring within 2-12 hours of illness onset and 16 (22.54%) cases of death occurring more than 12 hours. The death cases with delayed prenatal diagnosis or treatment and postpartum blood transfusion more than 2,000 ml accounted for 26.76% (19/71) and 39.43% (28/71) respectively. There were 43.66% (31/71) death cases with delayed postpartum blood transfusion, of which 23 death cases induced by blood supply deficiency and 8 by bleeding volume estimation error. County emergency obstetric care expert group was initiated and involved in the treatment of 29.58% (21/71) death cases during the county rescue process. The provincial-level assessment indicated that 46.48% (33/71) of the death cases were inevitable and 53.5% (38/71) were avoidable. Conclusions More attention should be paid to primiparas who have postpartum hemorrhage or acute hypoxia as the first manifestation in the county-level medical institutions with the limited medical software and hardware. It is necessary to improve the consciousness of early identification, timely initiate multidisciplinary synergetic rescue and treatment and guarantee blood supply so as to strive to boost the rescue success rate. Diagnosis of amniotic fluid embolism is largely based on clinical manifestations, which may be inaccurate; and hence, the proportion of autopsy should be increased in the future to clarify the causes of death.
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2017, Vol. 24 
