Clinical coagulopathy was defined as an incoagulable maternal hemorrhage of unknown origin during the intrapartum or postpartum period. Massive obstetric hemorrhage was defined as a bleeding volume of >1,000 mL. Of these, we also identified the first manifested symptom. ĪFE symptoms were classified into 5 groups as follows: cardiovascular collapse (cardiac arrest), hypotension, respiratory compromise (dyspnea, coughing, cyanosis, shortness of breath), clinical coagulopathy, and neurological signs (restlessness, confusion, agitation, numbness, tingling, fainting, mental change, and seizure). In Japan, AFE is defined if 1) symptoms appeared during pregnancy or within 12 hours of delivery 2) intensive medical intervention was conducted to treat ≥1 of the following symptoms/diseases: (a) cardiac arrest, (b) severe bleeding of unknown origin within 2 hours of delivery (≥1,500 mL), (c) disseminated intravascular coagulation (DIC), or (d) respiratory failure 3) findings or symptoms obtained could not be explained by other diseases and 4) consumptive coagulopathy/DIC due to evident etiologies, such as abnormal placentation, trauma during labor, and severe preeclampsia/eclampsia, was excluded. “In the absence of any other clear cause, either 1) acute maternal collapse with one or more of the following features: acute fetal compromise, cardiac arrhythmias, etc., 2) excluding women with maternal hemorrhage as the first presenting feature, in whom there was no evidence of early coagulopathy or cardiorespiratory compromise or 3) women in whom the diagnosis was established during post-mortem examination by finding fetal squamous cells or hair in the lungs”. In the United Kingdom, AFE is defined as follows. For example, the diagnostic criteria in Australia are based on “clinical diagnosis, including acute hypotension or cardiac arrest, acute hypoxia, or coagulopathy in the absence of any other potential explanation for signs and symptoms observed or pathologic diagnosis of fetal squamous cells or hair in lungs”. Several countries have provided diagnostic criteria for AFE, which are not in complete agreement with each other. In general, AFE is clinically diagnosed as sudden cardiovascular collapse, after exclusion of other possible causes.
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