We appreciate Professor Erez’s interest1 on the subject of the diagnosis of amniotic fluid embolism, disseminated intravascular coagulation (DIC), and the proposed criteria by the expert group published in the Journal.2
The criteria proposed by our group to standardize the case definition of amniotic fluid embolism for research purposes was derived by extensive consultation with experts in the field, including in the area of hemostasis. Our proposed criteria uses a modification of the criteria of the International Society on Thrombosis and Hemostasis.3 Other alternatives were considered by the group and we decided on the ones published as representing the state of the art at the time of the meeting and submission and acceptance of the manuscript.
Professor Erez has proposed a criteria for the diagnosis of DIC in obstetrics, taking into account the physiologic changes in the hemostatic system associated with normal pregnancy, and tested such criteria clinically in a wide range of pregnancy complications.4 The criteria proposed by Dr Erez and his team are largely applicable to the complications in their report, which included preeclampsia, fetal death, abruptio placenta, and postpartum hemorrhage. There were no cases of amniotic fluid embolism in their report.4 We appreciate Professor Erez’s calculations of our modified criteria in the detection of DIC in other obstetrical complications. However, it remains to be determined if these criteria perform as well in a population of patients with amniotic fluid embolism as they do in other complications of pregnancy. We plan to continue with the use of the modified criteria reported in our publication but are open to record the data and to evaluate different criteria in the future, as our registry gathers data and patients.
Footnotes
Disclosure: The authors report no conflict of interest.
Contributor Information
Steven Clark, Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
Roberto Romero, Wayne State University, Detroit, MI. Epidemiology and Biostatistics, Michigan State University, East Lansing, MI. Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
Michael Belfort, Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
Gary Dildy, Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
References
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