A new approach to the pathomechanism of amniotic fluid embolism: unknown role of amniotic cells in the induction of disseminated intravascular coagulation

There are four concepts (theories) of amniotic fluid embolism (AFE). The aim of the study was to perform their critical review and to popularize a novel integrated concept. We searched Medline (from its inception to 2011), using key words: amniotic fluid embolism, amniotic cells, tissue factor, leukotriene and microparticles. Articles most eligible for the study of etiopathomechanism of AFE were chosen by title and/or abstract contents. The analysis of the publications revealed that: (i) the integrated concept of AFE is an adequate tool to interpret the complication, being particularly useful for taking direct therapeutic decisions; (ii) disseminated intravascular coagulation (DIC) in this complication is induced not by tissue factor (TF) of amniotic origin but by spectacular procoagulant activity of apoptosis-affected amniotic cells. Descriptions of molecular processes were provided. In clonclusioin, there are two independent pathways of AFE–the DIC pathway and the leukotriene pathway. It is not the TF but the apoptosis-affected amniotic cells that are responsible for the process of DIC in AFE. 3. One of the therapeutic conclusions of the new approach to the concept of AFE indicates that attempts to use heparin in AFE are justified (at the onset of the complication).