Patients often feel imminent danger: Amniotic fluid embolism may not be so rare. (Obstetrics).

VAIL, COLO,. -- Amniotic fluid embolism may be vastly more common than the medical literature would indicate, Dr. Gary D.V. Hankins said at a conference on obstetrics and gynecology sponsored by the University of Colorado.

When he asked the audience of several hundred ob.gyns. how many had ever cared for a patient with amniotic fluid embolism, more than one-third raised their hands. And when he asked all those in the audience who had a practice partner who had confronted a case to raise their hands as well, virtually everyone in the room had their hand up.

That's the typical response when he poses this question to obstetric audiences around the country, according to Dr. Hankins, professor and vice chair of ob.gyn. at the University of Texas, Galveston.

In contrast, the registry data would suggest that amniotic fluid embolism (AFE) is exceedingly rare. The Swedish National Registry, for example, concluded that there is one death due to AFE for every 83,000 live births. In Great Britain, a case was diagnosed either clinically or pathologically once per 78,000 live births.

"The registries use very stringent diagnostic criteria. In reality, I think the true incidence of this disorder is closer to 1 in 8,000. Otherwise, we wouldn't have all of us in this room raising our hands because we've been exposed to it," he said.

Dr. Hankins has a long-standing research interest in AFE. He's done studies of the phenomenon in animal models, and he collaborated on the U.S. registry. The ob.gyn. characterized APE as "a catastrophe that leads to disaster for at least one in two patients."

The maternal case fatality rate in the Swedish registry was 66%. In the U.S. registry, it was 61%. Overall, intact maternal survival in the U.S. study was a paltry 15%. Half of survivors experienced permanent neurologic impairment due to ...