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Re: Still another GOOD DAY [longFrom: allanho@aol.comSat Mar 8 18:51:22 2008
I try not to judge, but I do sometimes feel that warnings are appropriate. When I learned that the CDC doesn't get accurate numbers from the states, that the states don't all use the same birth certificates or death certificates or even word questions in the same way and that the underreporting problem is as bad as the CDC has written that it is, I began making the quilt to raise awareness. In a weird way, I'm getting a kind of random sample, except that there is probably a bias in that it's easier for me to hear about maternal deaths after a home birth was attempted than one after exclusively hospital-based care. That said, I'm finding surprising numbers of AFEs after induced labor (21/172), various complications following c-section, and postpartum deaths (during the first 14 days).? Ina May TI Amniotic fluid embolism: analysis of the national registry. AU Clark SL; Hankins GD; Dudley DA; Dildy GA; Porter TF SO Am J Obstet Gynecol 1995 Apr;172(4 Pt 1):1158-67; discussion 1167-9. ? OBJECTIVE: We analyzed the clinical course and investigated possible pathophysiologic mechanisms of amniotic fluid embolism. STUDY DESIGN: We carried out a retrospective review of medical records. Forty-six charts were analyzed for 121 separate clinical variables. RESULTS: Amniotic fluid embolism occurred during labor in 70% of the women, after vaginal delivery in 11%, and during cesarean section after delivery of the infant in 19%. No correlation was seen with prolonged labor or oxytocin use. A significant relation was seen between amniotic fluid embolism and male fetal sex. Forty-one percent of patients gave a history of allergy or atopy. Maternal mortality was 61%, with neurologically intact survival seen in 15% of women. Of fetuses in utero at the time of the event, only 39% survived. Clinical and hemodynamic manifestations were similar to those manifest in anaphylaxis and septic shock. CONCLUSIONS: Intact maternal or fetal survival with amniotic fluid embolism is rare. The striking similarities between clinical and hemodynamic findings in amniotic fluid embolism and both anaphylaxis and septic shock suggest a common pathophysiologic mechanism for all these conditions. Thus the term amniotic fluid embolism appears to be a misnomer. ? AD Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, USA. Ina May, I don't know where you get your numbers from.? In any case, what does it have to do with accepting an English (as opposed to Amish) primigravida with a macroscomic baby (almost 9 lbs before the meconium was squeezed out) delivering at home??? If you apply your practice in the general population, there will certainly be a lot more tragic outcomes. Allan
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