Amniotic-fluid embolism is a leading cause of maternal mortality, with recent rates appearing to have increased in some countries1,2 although not in others.3,4 There were no changes in diagnostic criteria or methods of case ascertainment to account for the observed rise in the number of deaths in the United Kingdom and Australia, but the rarity of the disorder makes it particularly difficult to investigate whether the larger number of deaths reflects an increase in the incidence of the condition, an increase in the case fatality, or a chance finding. Two recent retrospective analyses of incidence using large national hospital databases in the United States and Canada,3,4 did not find a temporal trend in the occurrence of fatal or nonfatal cases.
Prospective surveillance of amniotic-fluid embolism has been undertaken in the United Kingdom through two routes. In a passive system, between 1997 and 2004, cases were reported on a voluntary basis to the United Kingdom Amniotic Fluid Embolism Register5; since 2005, cases have been reported actively on a national basis through the routine monthly mailing of the UK Obstetric Surveillance System.6 The aim of this study was to estimate the current incidence of amniotic-fluid embolism in the United Kingdom and to investigate whether there is any evidence to suggest that disease incidence is changing. In addition, we sought to describe risk factors, current management, case fatality, and other outcomes.
Amniotic-fluid embolism is a leading cause of maternal mortality, with recent rates appearing to have increased in some countries1,2 although not in others.3,4 There were no changes in diagnostic criteria or methods of case ascertainment to account for the observed rise in the number of deaths in the United Kingdom and Australia, but the rarity of the disorder makes it particularly difficult to investigate whether the larger number of deaths reflects an increase in the incidence of the condition, an increase in the case fatality, or a chance finding. Two recent retrospective analyses of incidence using large national hospital databases in the United States and Canada,3,4 did not find a temporal trend in the occurrence of fatal or nonfatal cases.Prospective surveillance of amniotic-fluid embolism has been undertaken in the United Kingdom through two routes. In a passive system, between 1997 and 2004, cases were reported on a voluntary basis to the United Kingdom Amniotic Fluid Embolism Register5; since 2005, cases have been reported actively on a national basis through the routine monthly mailing of the UK Obstetric Surveillance System.6 The aim of this study was to estimate the current incidence of amniotic-fluid embolism in the United Kingdom and to investigate whether there is any evidence to suggest that disease incidence is changing. In addition, we sought to describe risk factors, current management, case fatality, and other outcomes.
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