Pathogenetic role of MSAF during delivery on hemorrhage in AFE with isolated coagulopathy.

What is it about?

Further goals of the study, not less scientifically relevant, were: 1) To prove that amniotic fluid can frequently enter in the maternal circulation during delivery through small vessel lacerations or open vessel termination of the placental area, even if it is hard to demonstrate the real incidence (Abstract: “ Our aim was demonstrate that hemorrhage caused by AFE related isolated coagulopathy is worsened if amniotic fluidi is contaminated by meconium (MSAF Meconium Stained Amniotic Fluid). We calculated retrospectively the incidence of MSAF (1 case on 6,7 in our population), then we saw the differences in the incidence of stained or not stained amniotic fluid in patients with blood loss over 1.000 c.c, but less than 2.000 c.c. ( p= 0.00001, RR=1.3, IC 95% 1.1-1.4) and over or equal to 2.000 c.c. (p=0.0005, RR=2.0, IC 95% 1.1-1.4). Our results suggest that a relevant number of post-partum hemorrhage may be due to a kind of coagulopathy caused by passage of amniotic fluid in maternal venous compartments of the genital area. Meconium represents a further risk factor for maternal hemorrhage”. 2) Amniotic fluid embolism is always a pathological event, even if rare, as it is responsible of a complex cardiorespiratory syndrome, that can give rise to an even more complex form of coagulopathy that is more evident in the vessel area interested by the entrance of amniotic fluid in the maternal circulation.

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Why is it important?

The peculiarity of our article is that it proved the different hemorrhagic impact in the cases of the presence of meconium in the amniotic fluid or not. We indirectly demonstrate than that the amniotic fluid embolism is quite frequent otherwise we could have not shown so much difference between the two groups. There is no other reason to physiopathologically justify these differences.

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