{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T06:06:20Z","timestamp":1780639580967,"version":"3.54.1"},"reference-count":14,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2012,4,24]],"date-time":"2012-04-24T00:00:00Z","timestamp":1335225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2012,6]]},"abstract":"<jats:p><jats:italic>Please cite this paper as:<\/jats:italic> Kramer M, Rouleau J, Liu S, Bartholomew S, Joseph K for the Maternal Health Study Group of the Canadian Perinatal Surveillance System. Amniotic fluid embolism: incidence, risk factors, and impact on perinatal outcome. BJOG 2012;119:874\u2013879.<\/jats:p><jats:p><jats:bold>Objective\u2002<\/jats:bold> To extend our previous work on AFE in Canada by including stricter criteria for case identification and by examining risks for stillbirth, neonatal mortality and serious maternal and neonatal morbidity.<\/jats:p><jats:p><jats:bold>Design\u2002<\/jats:bold> Population\u2010based cohort study.<\/jats:p><jats:p><jats:bold>Setting\u2002<\/jats:bold> Canada.<\/jats:p><jats:p><jats:bold>Population or sample\u2002<\/jats:bold> In all, 4\u2003508\u2003462 hospital deliveries from fiscal year 1991\/92 to 2008\/09.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> To reduce false\u2010positive diagnoses, we restricted our analysis to AFE cases with cardiac arrest, shock or severe hypertension, respiratory distress, mechanical ventilation, coma, seizure, or coagulation disorder. Linkage of maternal and neonatal records, available since 2001\/02, enabled us to examine the effects of AFE on neonatal outcomes. Detailed demographic and clinical data facilitated control for a broad array of potential confounding variables.<\/jats:p><jats:p><jats:bold>Main outcome measures\u2002<\/jats:bold> Amniotic fluid embolism, in\u2010hospital neonatal death, asphyxia, mechanical ventilation, bacterial sepsis, seizure, nonimmune haemolytic or traumatic jaundice and length of hospital stay.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> A total of 292 AFE cases were identified, of which only 120 (40%) were confirmed after applying our additional diagnostic criteria, yielding an AFE incidence of 2.5 per 100\u2003000 deliveries. Of the 120 confirmed cases, 33 (27%) were fatal. Significant modifiable risk factors included medical induction, caesarean delivery, instrumental vaginal delivery, and uterine or cervical trauma. Amniotic fluid embolism was associated with significantly increased risks of stillbirth and neonatal asphyxia, mechanical ventilation, sepsis, seizures and prolonged length of hospital stay.<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold> Amniotic fluid embolism remains a rare but serious obstetric outcome, with several important modifiable risk factors and major implications for maternal, fetal and neonatal health.<\/jats:p>","DOI":"10.1111\/j.1471-0528.2012.03323.x","type":"journal-article","created":{"date-parts":[[2012,4,24]],"date-time":"2012-04-24T23:22:02Z","timestamp":1335309722000},"page":"874-879","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Amniotic fluid embolism: incidence, risk factors, and impact on perinatal outcome"],"prefix":"10.1111","volume":"119","author":[{"given":"MS","family":"Kramer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Rouleau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Bartholomew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KS","family":"Joseph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Maternal Health Study Group of the Canadian Perinatal Surveillance System","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,4,24]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1159\/000298984"},{"key":"e_1_2_10_3_2","first-page":"1055","article-title":"Maternal mortality in the United States, 1979\u20131986","volume":"76","author":"Atrash HK","year":"1990","journal-title":"Obstet Gynecol"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.04.052"},{"key":"e_1_2_10_5_2","first-page":"31","article-title":"Cause\u2010specific mortality during and after pregnancy and the definition of maternal death","volume":"23","author":"Turner LA","year":"2002","journal-title":"Chronic Dis Can"},{"key":"e_1_2_10_6_2","volume-title":"Special Report on Maternal Mortality and Severe Morbidity in Canada \u2013 Enhanced Surveillance: The Path to Prevention","author":"Health Canada","year":"2004"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1979.tb04862.x"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006254-199006000-00003"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69607-4"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02656.x"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181d9f629"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.11.061"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-12-7"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318178eae4"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.108.2.e35"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1471-0528.2012.03323.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1471-0528.2012.03323.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T14:45:25Z","timestamp":1698763525000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/j.1471-0528.2012.03323.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,4,24]]},"references-count":14,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2012,6]]}},"alternative-id":["10.1111\/j.1471-0528.2012.03323.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1471-0528.2012.03323.x","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,4,24]]},"assertion":[{"value":"2012-04-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}