Robert Brown: Standardizing Amniotic Fluid Embolism Diagnosis – SMFM and AFE Foundation Criteria
Robert Brown, Academic Obstetrician, shared a post on LinkedIn:
“Diagnostic criteria for Amiotic Fluid Embolism
A working group of the Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation proposed a definition of AFE based on the presence of four diagnostic criteria, all of which must be present.
It provides standardization for research purposes but may also be useful clinically.
While patients who meet these criteria may be confidentially diagnosed with AFE, at least one-quarter of patients will not meet these criteria.
Criteria for AFE (all must be present):
Sudden onset of cardiopulmonary arrest or hypotension (systolic blood pressure less than 90 mmHg) with evidence of respiratory compromise (eg, dyspnea, cyanosis, or peripheral oxygen saturation less than 90 percent ).
Documentation of overt DIC using the scoring system of the Scientific and Standardization Committee on DIC of the International Society on Thrombosis and Hemostasis modified for pregnancy:
Platelet count greater than 100,000 is equal to 0 points, less than 100,000 is equal to 1 point, less than 50,000 is equal to 2 points.
Prolonged prothrombin time or international normalized less than 25 percent increase is equal to 0 points, 25-50 percent increase is equal to 1 point, greater than 50 percent increase is equal to 2 points
Fibrinogen level greater than 200 mg/dL is equal to 0 points, less than 200mg/dL is equal to 1 point
A score of 3 or more is compatible with overt DIC. Coagulopathy must be detected before hemorrhage itself can account for dilutional or shock-related consumptive coagulopathy
Clinical onset during labor or within 30 minutes of placental delivery
Absence of fever (38 degrees or more) during labor.”
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