Amniotic components in the uterine vasculature and their role in amniotic fluid embolism

• Published in: The journal of obstetrics and gynaecology research Vol. 41; no. 6; pp. 870 - 875
• Main Authors: Nakagami, Hiroko, Kajihara, Takeshi, Kamei, Yoshimasa, Ishihara, Osamu, Kayano, Hidekazu, Sasaki, Atsushi, Itakura, Atsuo
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.06.2015
• Subjects: alcian blue; Amniotic Fluid - chemistry; amniotic fluid embolism; Antigens, Tumor-Associated, Carbohydrate - blood; Antigens, Tumor-Associated, Carbohydrate - chemistry; Biomarkers - blood; disseminated intravascular coagulation; Disseminated Intravascular Coagulation - etiology; Embolism, Amniotic Fluid - blood; Embolism, Amniotic Fluid - physiopathology; Female; Hospitals, University; Humans; Japan; post-partum hysterectomy; Postpartum Hemorrhage - etiology; Pregnancy; Reproducibility of Results; Retrospective Studies; Uterus - blood supply; Uterus - chemistry; post-partum hysterectomy; alcian blue; disseminated intravascular coagulation; amniotic fluid embolism
• ISSN: 1341-8076; 1447-0756; 1447-0756
• DOI: 10.1111/jog.12650

Aim To evaluate whether the presence of amniotic components in the maternal uterine vasculature could be a specific pathological indicator for amniotic fluid embolism (AFE). Methods Medical records of patients treated between January 2006 and March 2013 were retrospectively examined to identify patients who underwent post‐partum hysterectomy or autopsy due to maternal death. Three subjects with AFE with disseminated intravascular coagulation (DIC)‐type post‐partum hemorrhage (PPH), and 13 non‐AFE subjects were included in analysis. Histochemical staining using hematoxylin–eosin (HE) and alcian blue, and immunohistochemical staining for sialyl‐Tn were conducted to detect amniotic components in the maternal uterine vasculature. Results Alcian blue was positive for amniotic components in the uterine vasculature of all subjects with AFE and of several subjects without AFE. Similarly, HE and sialyl‐Tn were negative in some AFE subjects and positive in some non‐AFE subjects. Conclusions The presence of maternal intravascular fetal material is not a specific indicator for AFE with DIC‐type PPH. Therefore, the presence of fetal components in the uterine vasculature is unlikely to be a definitive indicator for AFE.