A basic study on the reaction system of amniotic fluid fetal component and maternal for the pathogenesis of amniotic fluid embolism

2020 Fiscal Year Final Research Report

• Project/Area Number: 18K09225
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 56040:Obstetrics and gynecology-related
• Research Institution: Hamamatsu University School of Medicine
• Principal Investigator: Tamura Naoaki 浜松医科大学, 医学部, 講師 (90402370)
• Co-Investigator(Kenkyū-buntansha): 金山 尚裕 浜松医科大学, 医学部, 副学長 (70204550) ; 伊東 宏晃 浜松医科大学, 医学部, 教授 (70263085)
• Project Period (FY): 2018-04-01 – 2021-03-31
• Keywords: 羊水塞栓症 / 播種性血管内凝固 / 凝固線溶系 / 血栓

Outline of Final Research Achievements

We analysed the direct reaction between amniotic fluid and maternal blood by utilizing Rotational thromboelastometry (ROTEM). Our data suggests amniotic fluid accelerated thrombin production and activated platelet aggregation without inducing hyperfibrinolysis in whole blood. The activated tissue factor tissue factor pathway with amniotic fluid produced soft and fragile clots due to its influence on platelets.
We also measured ETP with four different amounts of amniotic fluid followed by the calculation of APC-sr. Our result indicates amniotic fluid reduced susceptibility to APC and attenuated the maternal APC anti-coagulation system, which may have partly contributed to enhanced maternal blood coagulation caused by amniotic fluid contamination.

Free Research Field

周産期医学

Academic Significance and Societal Importance of the Research Achievements

羊水と母体血液の反応として、羊水は血液凝固反応を促進し血小板凝集を活性化したが線溶亢進を誘導しなかった。羊水によってさらに活性化された組織因子経路のもとでは血小板に影響し、脆弱な血餅がつくられた。これらの結果は、羊水塞栓症による肺動脈塞栓のメカニズムとして、羊水・胎児成分による機械的閉塞だけでなく、分娩後早期の組織因子経路活性化に伴う播種性血管内凝固症候群および血栓塞栓が関与することを示唆しており、羊水塞栓症における心肺虚脱の病態解明につながるものと期待される。