Intravenous injection of autologous amniotic fluid induces transient thrombocytopenia in a gravid rabbit model of amniotic fluid embolism

Rannou, Benoît; Rivard, Georges E.; Gains, Malcolm J.; Bédard, Christian

doi:10.1111/j.1939-165x.2011.00369.x

Cited by 9 publications

(2 citation statements)

References 32 publications

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“…The authors concluded that other factors such as the presence of meconium in AF may be needed to provoke more severe clinical signs. 36 Since AF cannot be absorbed through vaginal mucosa, it can be hypothesized that coagulopathy and subsequent hemorrhage are caused by the entrance of AF into maternal circulation. It has been reported that this event is frequent, 37 and several cases of AF embolism with isolated coagulopathy have been reported.…”

Section: Discussionmentioning

confidence: 99%

Meconium-stained amniotic fluid: a risk factor for postpartum hemorrhage

Bouchè¹,

Wiesenfeld²,

Ronfani³

et al. 2018

TCRM

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Background/aimClinical data with respect to the impact of meconium on the risk of maternal hemorrhage are scarce. Therefore, in this study, we aimed to determine whether meconium-stained amniotic fluid (MSAF) represents a risk factor for postpartum hemorrhage (PPH) after vaginal delivery in a large unselected population.Patients and methodsA retrospective cohort study evaluated 78,542 consecutive women who had a vaginal delivery between 24th and 44th weeks of gestation. The women who had undergone cesarean section were excluded to avoid possible bias. Postpartum blood loss was measured with graduated blood sack. Postpartum blood loss between 1,000 and 2,000 mL and >2,000 mL were classified as moderate and severe PPH, respectively.ResultsA total of 74,144 patients were available for analysis. According to the color of amniotic fluid (AF), two groups of patients were identified: MSAF (n=10,997) and clear AF (n=63,147). The rates of severe and massive PPH were found to be significantly higher in the MSAF group than that of clear AF group (OR=1.3, 95% CI: 1.2–1.5, p<0.001 and OR=2.5, 95% CI: 1.5–4.2, p<0.001). Operative vaginal delivery rate was found to be higher in the MSAF group than that of clear AF group, but the difference was only borderline significant (OR=1.5, 95% CI: 1.0–2.2, p=0.05). There were no significant differences between the MSAF and the clear AF groups with respect to episiotomies, second- or third-degree perineal tears, vaginal–perineal thrombus, cervical lacerations, vaginal births after cesarean section, twin deliveries, and placental retention rates.ConclusionTo the best of our knowledge, this is the first clinical study that has investigated the role of MSAF as a risk factor for PPH after vaginal delivery in an unselected population. Our results suggest that MSAF is significantly associated with higher risk of moderate and severe PPH than clear AF.

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Section: Discussionmentioning

confidence: 99%

Meconium-stained amniotic fluid: a risk factor for postpartum hemorrhage

Bouchè¹,

Wiesenfeld²,

Ronfani³

et al. 2018

TCRM

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“…6,7 Amniotic fluid is also a source of the coagulation initiator tissue factor and has been shown to induce transient thrombocytopenia in the rabbit model. 25,26 However, investigators have reached contradictory conclusions as to whether the amount of procoagulant in clear amniotic fluid is sufficient to cause clinically significant coagulopathy. 6,7,25 High levels of tissue factor pathway inhibitor found in amniotic fluid during late pregnancy would inhibit procoagulant activity and may actually contribute to the rarity of this condition.…”

Section: Pathophysiologymentioning

confidence: 98%

Amniotic Fluid Embolism

Clark

2014

Obstetrics &Amp; Gynecology

154

129

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Amniotic fluid embolism remains one of the most devastating conditions in obstetric practice with an incidence of approximately 1 in 40,000 deliveries and a reported mortality rate ranging from 20% to 60%. The pathophysiology appears to involve an abnormal maternal response to fetal tissue exposure associated with breaches of the maternal-fetal physiologic barrier during parturition. This response and its subsequent injury appear to involve activation of proinflammatory mediators similar to that seen with the classic systemic inflammatory response syndrome. Progress in our understanding of this syndrome continues to be hampered by a lack of universally acknowledged diagnostic criteria, the clinical similarities of this condition to other types of acute critical maternal illness, and the presence of a broad spectrum of disease severity. Clinical series based on population or administrative databases that do not include individual chart review by individuals with expertise in critical care obstetrics are likely to both overestimate the incidence and underestimate the mortality of this condition by the inclusion of women who did not have amniotic fluid embolism. Data regarding the presence of risk factors for amniotic fluid embolism are inconsistent and contradictory; at present, no putative risk factor has been identified that would justify modification of standard obstetric practice to reduce the risk of this condition. Maternal treatment is primarily supportive, whereas prompt delivery of the mother who has sustained cardiopulmonary arrest is critical for improved newborn outcome.

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