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Master Thesis

Embolie de liquide amniotique : évaluation de son incidence, de ses facteurs de risque, de son diagnostic positif et de sa prise en charge médicale. Étude rétrospective et multicentrique sur 20 cas entre 2003 et 2009, au sein de 12 maternités de l'AP-HP

Abstract : Amniotic fluid embolism: evaluation of its incidence, of its risk factors, its positive diagnosis and its medical care. Multicenter retrospective study on 20 cases between 2003 and 2009 in 12 maternity hospitals of the AP-HP. In 2010, the amniotic fluid embolism (AFE) is the second leading cause of maternal mortality in France (12%) after postpartum hemorrhage. Risk factors are poorly understood, the clinical picture is variable and there is no pathognomonic paraclinical examination validated. The midwife is in most cases, alone with the patient at the time of its occurrence and plays a major role in the implementation of the initial resuscitation. That's why we conducted a retrospective multicenter study in 12 maternity wards of the AP-HP from 1 January 2003 and May 31, 2009. Twenty cases of suspected ELA were collected. Our study aimed to determine the incidence of AFE, identify potential risk factors, clinical presentation and management done. We found an incidence of AFE to 1/8 648 deliveries. Maternal mortality and neurological morbidity were respectively 25% and 20%, fetal morbidity was 37.5% with a delay of extraction of 19.5 ± 15 minutes. Potential risk factors were: abnormal placenta insertion (p<0.001), abruption placenta (p<0.001), induction of labor (p<0.005), therapeutic abortion (p<0.001), caesarean section (p=0.03), ethnicity in sub-Saharan Africa (p<0.001) and male fetus (p=0.01). The main clinical signs were a shock cardiovascular (75%), respiratory distress (60%), DIC (70%) and neurological disorders (55%). The initial management by non-specific team can be improved. Indeed, the duration of no flow (the time without chest compression in the first period of cardiac arrest) was longer in patients who died (6±3.5 versus 2±1.4 minutes) while midwives were already there. Moreover, the arrival of the special team was longer among women who died (7.5±4.8 versus 3.2±4.8 minutes). Moreover, only 50% of patients were referred for diagnostic tests when they could help confirm a suspicion. On the other hand, only 18% of pregnancies had a specific protocol on the AFE and 45% were organizing special training on the vital urgency. The improvement of maternal-fetal prognosis is therefore based on the training of professionals, establishing a written protocol, the transmission of information within the team and control of these shares over the long term. The creation of a French or european national registry would be a tool to assess the epidemiology of this disease in France and try to understand its pathophysiology.
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https://dumas.ccsd.cnrs.fr/dumas-00593948
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Submitted on : Wednesday, May 18, 2011 - 11:24:55 AM
Last modification on : Friday, October 23, 2020 - 4:49:23 PM
Long-term archiving on: : Friday, August 19, 2011 - 2:22:32 AM

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  • HAL Id : dumas-00593948, version 1

Citation

Hanna Munganeemea. Embolie de liquide amniotique : évaluation de son incidence, de ses facteurs de risque, de son diagnostic positif et de sa prise en charge médicale. Étude rétrospective et multicentrique sur 20 cas entre 2003 et 2009, au sein de 12 maternités de l'AP-HP. Gynécologie et obstétrique. 2010. ⟨dumas-00593948⟩

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