Consumptive Coagulopathy Involving Amniotic Fluid Embolism: The Importance of Earlier Assessments for Interventions in Critical Care

Oda, Tomoaki; Tamura, Naoaki; Ide, Rui; Itoh, Takeshi; Horikoshi, Yoshimasa; Matsumoto, Masako; Narumi, Megumi; Kohmura-Kobayashi, Yukiko; Furuta-Isomura, Naomi; Yaguchi, Chizuko; Uchida, Toshiyuki; Suzuki, Kazunao; Itoh, Hiroaki; Kanayama, Naohiro

doi:10.1097/ccm.0000000000004665

Cited by 19 publications

(15 citation statements)

References 30 publications

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“…2 Fibrinogen supplementation is essential to correct the coagulopathy, but concentrated fibrinogen supplementation is not called for in the MTP. 2,3 Recently, point-of-care using viscoelastic hemostatic testing, which includes thromboelastography or ROTEM, has grown in importance over laboratory assays, such as hemoglobin/hematocrit/platelet or basic coagulation profile (activated partial thromboplastin time or prothrombin time). [4][5][6][7] One reason is that a delay in intervention from the slow laboratory assay reporting can cause deteriorating obstetric hemorrhage.…”

Section: Commentmentioning

confidence: 99%

“…However, the MTP may be inappropriate where the composition of each blood product is not matched to the etiology causing hemorrhage. In severe obstetric hemorrhage complicated with consumptive coagulopathy, such as from amniotic fluid emboli, fibrinogen falls below the threshold for hemostasis from the early stage of bleeding 2. Fibrinogen supplementation is essential to correct the coagulopathy, but concentrated fibrinogen supplementation is not called for in the MTP 2,3.…”

Section: Commentmentioning

confidence: 99%

“…In severe obstetric hemorrhage complicated with consumptive coagulopathy, such as from amniotic fluid emboli, fibrinogen falls below the threshold for hemostasis from the early stage of bleeding 2. Fibrinogen supplementation is essential to correct the coagulopathy, but concentrated fibrinogen supplementation is not called for in the MTP 2,3. Recently, point-of-care using viscoelastic hemostatic testing, which includes thromboelastography or ROTEM, has grown in importance over laboratory assays, such as hemoglobin/hematocrit/platelet or basic coagulation profile (activated partial thromboplastin time or prothrombin time) 4–7.…”

Section: Commentmentioning

confidence: 99%

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The Sensitivity and Specificity of Rotational Thromboelastometry (ROTEM) to Detect Coagulopathy During Moderate and Severe Postpartum Hemorrhage: A Prospective Observational Study

Bell¹,

Roberts²,

Pereira³

et al. 2022

Obstetric Anesthesia Digest

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(Int J Obstet Anes. 2022;49:103238) Viscoelastometric hemostatic assays, such as rotational thromboelastometry (ROTEM), offer rapid, point-of-care identification of coagulopathy during postpartum hemorrhage (PPH). Previous studies investigating the use of ROTEM have used a Delta ROTEM device. This study investigates the use of the ROTEM Sigma device, identifying the sensitivity, specificity, and positive or negative predictive values in patients with PPH.

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Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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The Sensitivity and Specificity of Rotational Thromboelastometry (ROTEM) to Detect Coagulopathy During Moderate and Severe Postpartum Hemorrhage: A Prospective Observational Study

Bell¹,

Roberts²,

Pereira³

et al. 2022

Obstetric Anesthesia Digest

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“…Use of POC-VHA has been described in several case reports. 64 65 66 POC-VHA results have enabled early diagnosis during maternal collapse, differentiating amniotic fluid embolus (AFE) from other causes of maternal collapse such as pulmonary embolus. Prompt POC-VHA algorithm-guided treatment has probably contributed to successful maternal outcomes.…”

Section: Incidence Of Coagulation Abnormalities In Pphmentioning

confidence: 99%

The Role of Thromboelastography during the Management of Postpartum Hemorrhage: Background, Evidence, and Practical Application

Collis

Bell

2022

Semin Thromb Hemost

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Postpartum hemorrhage (PPH) is a common cause of significant maternal morbidity and mortality that can be associated with coagulopathy, especially hypofibrinogenemia. There is interest in point-of-care viscoelastic hemostatic assays (POC-VHA) in PPH because prompt knowledge of coagulation status can aid diagnosis, identify cases of severe coagulopathy, and allow ongoing monitoring during rapid bleeding. The incidence of coagulopathy in most cases of PPH is low because of the procoagulant state of pregnancy, including raised fibrinogen levels of around 4 to 6 g/L. A Clauss fibrinogen of >2 g/L or POC-VHA equivalent has been found to be adequate for hemostasis during PPH. POC-VHA has been used successfully to diagnose hypofibrinogenemia (Clauss fibrinogen of ≤2 g/L) and guide fibrinogen treatment which has reduced bleed size and complications of massive transfusion. There are uncertainties about the use of POC-VHA to direct fresh frozen plasma and platelet administration during PPH. Several POC-VHA algorithms have been used successfully incorporated in the management of many thousands of PPHs and clinicians report that they are easy to use, interpret, and aid decision making. Due to the relative cost of POC-VHA and lack of definitive data on improving outcomes, these devices have not been universally adopted during PPH.

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“…Activation of blood coagulation and consumptive coagulopathy are characteristics of AFE 13 . The platelet count also variably decreases in patients with AFE 13 .…”

Section: Introductionmentioning

confidence: 99%

Massive platelet‐rich thrombus formation in small pulmonary vessels in amniotic fluid embolism: An autopsy study

Yamashita

Oda

Aman

et al. 2023

BJOG

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ObjectiveTo identify pulmonary/uterine thrombus formation in amniotic fluid embolism (AFE).DesignRetrospective, observational.SettingNationwide.PopulationEleven autopsy cases of AFE and control cases.MethodsWe assessed pulmonary and uterine thrombus formation and thrombus area in AFE and pulmonary thromboembolism (PTE) as a control. The area of platelet glycoprotein IIb/IIIa, fibrin, neutrophil elastase, citrullinated histone H3 (a neutrophil extracellular trap marker) and mast cell chymase immunopositivity was measured in 90 pulmonary emboli, 15 uterine thrombi and 14 PTE.Main outcome measuresPathological evidence of thrombus formation and its components in AFE.ResultsAmniotic fluid embolism lung showed massive thrombus formation, with or without amniotic emboli in small pulmonary arteries and capillaries. The median pulmonary thrombus size in AFE (median, 0.012 mm2; P < 0.0001) was significantly smaller than that of uterine thrombus in AFE (0.61 mm2) or PTE (29 mm2). The median area of glycoprotein IIb/IIIa immunopositivity in pulmonary thrombi in AFE (39%; P < 0.01) was significantly larger than that of uterine thrombi in AFE (23%) and PTE (15%). The median area of fibrin (0%; P < 0.001) and citrullinated histone H3 (0%; P < 0.01) immunopositivity in pulmonary thrombi in AFE was significantly smaller than in uterine thrombi (fibrin: 26%; citrullinated histone H3: 1.1%) and PTE (fibrin: 42%; citrullinated histone H3: 0.4%). No mast cells were identified in pulmonary thrombi.ConclusionsAmniotic fluid may induce distinct thrombus formation in the uterus and lung. Pulmonary and uterine thrombi formation may contribute to cardiorespiratory collapse and/or consumptive coagulopathy in AFE.

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Consumptive Coagulopathy Involving Amniotic Fluid Embolism: The Importance of Earlier Assessments for Interventions in Critical Care

Abstract: Supplemental Digital Content is available in the text.

Cited by 19 publications

References 30 publications

The Sensitivity and Specificity of Rotational Thromboelastometry (ROTEM) to Detect Coagulopathy During Moderate and Severe Postpartum Hemorrhage: A Prospective Observational Study

The Sensitivity and Specificity of Rotational Thromboelastometry (ROTEM) to Detect Coagulopathy During Moderate and Severe Postpartum Hemorrhage: A Prospective Observational Study

The Role of Thromboelastography during the Management of Postpartum Hemorrhage: Background, Evidence, and Practical Application

Massive platelet‐rich thrombus formation in small pulmonary vessels in amniotic fluid embolism: An autopsy study

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