Forensic aspects of post-mortem histological detection of amniotic fluid embolism

Abstract

Amniotic fluid embolism (AFE) continues to be one of the most feared and devastating complications of pregnancy. A reliable diagnosis can be made only upon histological examination. A detection of AFE every now and then has a relevant implication on medico-legal aspects of intrapartum or post-partum maternal death. However, there are only isolated reports in the literature concerning the detection interval of amniotic fluid elements after their transfer into the lungs. The objective of this study was to determine how long after the onset of clinical symptoms the elements of amniotic fluid may be detectable in the pulmonary circulation. An autopsy, as well as a histological and toxicological examination of 29 women, who died intrapartum or post-partum were performed. AFE was diagnosed in seven women (25%). The maximum survival time of the women with AFE and also the detection interval of AF in the pulmonary vasculature was 36 h. In the lungs of the women who did not die of AFE, amniotic fluid components were not found. Thus, there is no evidence for a physiologic occurrence of AFE. In women who die some days or even weeks after delivery as a consequence of a haemorrhagic shock following post-partum genital bleeding ensuing from uterine atony, AFE should be considered as a cause of a coagulopathy.

Immunohistochemical identification of prevalent right ventricular ischemia causing right heart failure in cases of pulmonary fat embolism

“…Similarly to other recent publications [46][47][48][49], this manuscript confirms the importance of the histological and immunohistochemical investigations in the routinely medico-legal practise.…”

Current Concepts of Immunology and Diagnosis in Amniotic Fluid Embolism

“…All four AFE patients had positive staining of the pulmonary vasculature while the control group of four women who died from non-AFE causes did not. A second study of twenty-seven maternal deaths found fetal material in 100% of AFE patients and none in those dying of non-AFE causes [57]. It should be noted that the study findings were problematic since the authors began with the assumption that any fetal material in the maternal vasculature was diagnostic of AFE.…”

Amniotic fluid aspiration in cases of SIDS

“…Deaths related to amniotic fluid are a classical task in legal medicine and are represented, from one side, by cases of embolism through uterine veins during labor and delivery [25,26] and, from the other side, by its possible aspiration in the airways of the newborn during delivery [27,28]. The aspiration of uncontaminated amniotic fluid has been repeatedly reported to be potentially lethal [9,13,14].…”