• Tomoaki Oda, Naoaki Tamura, Yi Shen, Yukiko Kohmura-Kobayashi, Naomi Furuta-Isomura, Chizuko Yaguchi, Toshiyuki Uchida, Kazunao Suzuki, Hiroaki Itoh, and Naohiro Kanayama.
• Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: tomoakingdom@outlook.jp.
• Thromb. Res. 2018 Dec 1; 172: 142-149.

IntroductionPulmonary thromboembolism (PTE) is a leading cause of maternal death and frequently occurs during early puerperium. Amniotic fluid components are frequently observed in the maternal circulation in parturition; however, it currently remains unclear whether amniotic fluid contamination in maternal blood is related to the high incidence of PTE in early postpartum.ObjectivesTo examine the influence of amniotic fluid on blood coagulation and fibrinolysis systems with thromboelastometry.Materials And MethodsTwenty-one pregnant women were recruited. We used whole citrated blood in ROTEM® (Tem Innovations GmbH, Munich, Germany), including the non-activated assay (NATEM), assessments for extrinsic (EXTEM) and intrinsic pathways (INTEM), fibrin polymerization (FIBTEM), and hyperfibrinolysis (APTEM), with amniotic fluid contamination, and measured the clotting time (CT), clot formation time (CFT), alpha, amplitude at 10 min (A10), maximum clot firmness (MCF), and lysis indices at 30 min (LI30) and 60 min (LI60).ResultsShort CT in all assays as well as short CFT, high alpha, and increased A10 and MCF in NATEM were observed with amniotic fluid contamination. A10 and MCF as well as LI30 and LI60 decreased in EXTEM. Decreased LI60 with the mixture of amniotic fluid was not improved by tranexamic acid in APTEM.ConclusionsAmniotic fluid accelerated thrombin production and activated platelet aggregation without inducing hyperfibrinolysis in whole blood. The activated tissue factor pathway with amniotic fluid produced soft and fragile clots due to its influence on platelets, which may be associated with, at least partly, the high incidence of PTE in early puerperium, particularly after cesarean section.Copyright © 2018 Elsevier Ltd. All rights reserved.

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