Factores clínicos asociados a desenlaces maternos adversos en mujeres con embolia de líquido amniótico: revisión sistemática de la literatura, 2015–2025
DOI:
https://doi.org/10.65415/tp179n82Palabras clave:
embolia de líquido amniótico; mortalidad materna; complicaciones del embarazo; factores de riesgo; cuidados críticos.Resumen
La embolia de líquido amniótico (ELA) es una emergencia obstétrica infrecuente, de inicio súbito y diagnóstico clínico de exclusión, capaz de producir colapso cardiorrespiratorio, coagulopatía y daño orgánico grave. El objetivo fue analizar la evidencia publicada entre 2015 y 2025 sobre factores clínicos asociados con desenlaces maternos adversos en mujeres con ELA. Se realizó una revisión sistemática cualitativa a partir de 500 registros exportados de Dimensions; tras cribado y evaluación de elegibilidad se incluyeron 20 estudios empíricos, contrastados con PubMed y fuentes editoriales para verificar metadatos y DOI. La evidencia procedió principalmente de cohortes, registros poblacionales, estudios retrospectivos y series clínicas. El paro cardiorrespiratorio al inicio fue el marcador pronóstico más consistente: en un estudio multicountry se asoció de forma ajustada con mortalidad, y un registro chino mostró una asociación aún mayor con ELA fatal. La coagulopatía precoz, la hipofibrinogenemia, la hemorragia masiva, el shock, la insuficiencia respiratoria y la disfunción multiorgánica acompañaron los cuadros más graves, aunque no siempre contaron con estimadores ajustados independientes. Entre las supervivientes se documentaron secuelas neurológicas, necesidad de UCI, ventilación, transfusión, histerectomía y soporte extracorpóreo. En conjunto, la gravedad inicial y la rápida progresión cardiorrespiratoria y hemostática definen el pronóstico más que los factores obstétricos predisponentes a desarrollar ELA.
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Bonnet, M.-P., Zlotnik, D., Saucedo, M., Chassard, D., Bouvier-Colle, M.-H., & Deneux-Tharaux, C. (2018). Maternal death due to amniotic fluid embolism: A national study in France. Anesthesia & Analgesia, 126(1), 175–182. https://doi.org/10.1213/ANE.0000000000002511
Cahan, T., De Castro, H., Kalter, A., & Simchen, M. J. (2021). Amniotic fluid embolism—implementation of international diagnosis criteria and subsequent pregnancy recurrence risk. Journal of Perinatal Medicine, 49(5), 546–552. https://doi.org/10.1515/jpm-2020-0391
Cao, X., Gui, Q., Yan, H., Wei, Y., Chen, X., Liang, D., Li, X., Wang, J., & Chen, B. (2025). A retrospective analysis of the incidence and risk factors for amniotic fluid embolism in cesarean deliveries. BMC Pregnancy and Childbirth, 25, 432. https://doi.org/10.1186/s12884-025-07527-x
Clark, S. L., Romero, R., Dildy, G. A., Callaghan, W. M., Smiley, R. M., Bracey, A. W., Hankins, G. D., D’Alton, M. E., Foley, M., Pacheco, L. D., Vadhera, R. B., Herlihy, J. P., Berkowitz, R. L., & Belfort, M. A. (2016). Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. American Journal of Obstetrics and Gynecology, 215(4), 408–412. https://doi.org/10.1016/j.ajog.2016.06.037
Erez, O., Mastrolia, S. A., & Thachil, J. (2015). Disseminated intravascular coagulation in pregnancy: Insights in pathophysiology, diagnosis and management. American Journal of Obstetrics and Gynecology, 213(4), 452–463. https://doi.org/10.1016/j.ajog.2015.03.054
Fitzpatrick, K. E., van den Akker, T., Bloemenkamp, K. W. M., Deneux-Tharaux, C., Kristufkova, A., Li, Z., Schaap, T. P., Sullivan, E. A., Tuffnell, D., & Knight, M. (2019). Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study. PLOS Medicine, 16(11), e1002962. https://doi.org/10.1371/journal.pmed.1002962
Ghosh, S., Kulkarni, S., Nambier, P., & Davade, T. (2025). Amniotic fluid embolism: Pathophysiological insights through analysis of case series. The Journal of Obstetrics and Gynecology of India, 75(Suppl 1), 616–618. https://doi.org/10.1007/s13224-024-02057-6
Ide, R., Oda, T., Todo, Y., Kawai, K., Matsumoto, M., Narumi, M., Kohmura-Kobayashi, Y., Furuta-Isomura, N., Yaguchi, C., Uchida, T., Suzuki, K., Kanayama, N., Itoh, H., & Tamura, N. (2024). Comparative analysis of hyperfibrinolysis with activated coagulation between amniotic fluid embolism and severe placental abruption. Scientific Reports, 14, 272. https://doi.org/10.1038/s41598-023-50911-w
Kim, J.-H., Seol, H.-J., Seong, W. J., Ryu, H. M., Bae, J. G., Hong, J.-S., Yang, J. I., Sung, J.-H., Choi, S. J., Oh, S. Y., & Roh, C. R. (2021). Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose. Obstetrics & Gynecology Science, 64(2), 190–200. https://doi.org/10.5468/ogs.20195
Matsunaga, S., Masuko, H., Takai, Y., Kanayama, N., & Seki, H. (2021). Fibrinogen may aid in the early differentiation between amniotic fluid embolism and postpartum haemorrhage: A retrospective chart review. Scientific Reports, 11, 8379. https://doi.org/10.1038/s41598-021-87685-y
Mazza, G. R., Youssefzadeh, A. C., Klar, M., Kunze, M., Matsuzaki, S., Mandelbaum, R. S., Ouzounian, J. G., & Matsuo, K. (2022). Association of pregnancy characteristics and maternal mortality with amniotic fluid embolism. JAMA Network Open, 5(11), e2242842. https://doi.org/10.1001/jamanetworkopen.2022.42842
McDonnell, N., Knight, M., Peek, M. J., Ellwood, D., Homer, C. S. E., McLintock, C., Vaughan, G., Pollock, W., Li, Z., Javid, N., Sullivan, E., & Australasian Maternity Outcomes Surveillance System (AMOSS). (2015). Amniotic fluid embolism: An Australian-New Zealand population-based study. BMC Pregnancy and Childbirth, 15, 352. https://doi.org/10.1186/s12884-015-0792-9
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Ponzio-Klijanienko, A., Vincent-Rohfritsch, A., Girault, A., Le Ray, C., Goffinet, F., & Bonnet, M.-P. (2020). Evaluation of the 4 diagnosis criteria proposed by the SMFM and the AFE Foundation for amniotic fluid embolism in a monocentric population. Journal of Gynecology Obstetrics and Human Reproduction, 49(9), 101821. https://doi.org/10.1016/j.jogoh.2020.101821
Schröder, L., Hellmund, A., Gembruch, U., & Merz, W. M. (2020). Amniotic fluid embolism-associated coagulopathy: A single-center observational study. Archives of Gynecology and Obstetrics, 301(4), 923–929. https://doi.org/10.1007/s00404-020-05466-w
Shen, F., Wang, L., Yang, W., & Chen, Y. (2016). From appearance to essence: 10 years review of atypical amniotic fluid embolism. Archives of Gynecology and Obstetrics, 293(2), 329–334. https://doi.org/10.1007/s00404-015-3785-z
Simard, C., Yang, S., Koolian, M., Shear, R., Rudski, L., & Lipes, J. (2021). The role of echocardiography in amniotic fluid embolism: A case series and review of the literature. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 68(10), 1541–1548. https://doi.org/10.1007/s12630-021-02065-4
Skolnik, S., Ioscovich, A., Eidelman, L. A., Davis, A., Shmueli, A., Aviram, A., & Orbach-Zinger, S. (2019). Anesthetic management of amniotic fluid embolism—A multi-center, retrospective, cohort study. Journal of Maternal-Fetal & Neonatal Medicine, 32(8), 1262–1266. https://doi.org/10.1080/14767058.2017.1404024
Society for Maternal-Fetal Medicine (SMFM), Pacheco, L. D., Saade, G., Hankins, G. D. V., & Clark, S. L. (2016). Amniotic fluid embolism: Diagnosis and management. American Journal of Obstetrics and Gynecology, 215(2), B16–B24. https://doi.org/10.1016/j.ajog.2016.03.012
Stafford, I. A., Moaddab, A., Dildy, G. A., Klassen, M., Berra, A., Watters, C., Belfort, M. A., Romero, R., & Clark, S. L. (2020). Amniotic fluid embolism syndrome: Analysis of the United States International Registry. American Journal of Obstetrics & Gynecology MFM, 2(2), 100083. https://doi.org/10.1016/j.ajogmf.2019.100083
Suissa, N., Czuzoj-Shulman, N., & Abenhaim, H. A. (2024). Amniotic fluid embolism: 20-year incidence and case-fatality trends in the United States. European Journal of Obstetrics & Gynecology and Reproductive Biology, 294, 92–96. https://doi.org/10.1016/j.ejogrb.2023.12.034
Susanu, C., Harabor, A., Vicoveanu, P., Vasilache, I.-A., & Călin, A.-M. (2024). Anesthetic considerations and outcomes in amniotic fluid embolism: A retrospective study over a 15-year period. Journal of Clinical Medicine, 13(10), 2916. https://doi.org/10.3390/jcm13102916
Tanaka, H., Katsuragi, S., Osato, K., Hasegawa, J., Nakata, M., Murakoshi, T., Yoshimatsu, J., Sekizawa, A., Kanayama, N., Ishiwata, I., & Ikeda, T. (2017). Value of fibrinogen in cases of maternal death related to amniotic fluid embolism. Journal of Maternal-Fetal & Neonatal Medicine, 30(24), 2940–2943. https://doi.org/10.1080/14767058.2016.1269166
Zhu, C., Xu, D., & Luo, Q. (2023). Fatal amniotic fluid embolism: Incidence, risk factors and influence on perinatal outcome. Archives of Gynecology and Obstetrics, 307(4), 1187–1194. https://doi.org/10.1007/s00404-022-06535-y
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Derechos de autor 2026 Encalada Campos Grecia Elizabeth, Caicedo Medina Katherine Soledad, Narvaez Romero Evelyn Johanna, Beltrán Alvarado Katherine Dayanna, Arreaga Molina Angely Andreina
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
