title: C1 esterase inhibitor activity in amniotic fluid embolism.
abstract: OBJECTIVE
  Amniotic fluid embolism exhibits activation of the complement system and the kallikrein-kinin and coagulofibrinolytic systems. C1 esterase inhibitor is a major inhibitor of C1 esterase and can inhibit plasma kallikrein and also factors XIIa and XIa. Its activity has been shown to be significantly lower in pregnancy and labor than in the nonpregnant state. The purpose of this study was to determine C1 esterase inhibitor activity levels in amniotic fluid embolism.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  A single university-based center.
  
  
  METHODS
  One hundred six cases with amniotic fluid embolism in a total of 194 singleton pregnant women between January 2010 and December 2011.
  
  
  METHODS
  None.
  
  
  RESULTS
  One hundred six cases of amniotic fluid embolism had applied to the Japan amniotic fluid embolism registration center in Hamamatsu University School of Medicine between January 2010 and December 2011. In amniotic fluid embolism cases, 85 cases were nonfatal and 21 cases were fatal. Eighty-eight women who delivered without amniotic fluid embolism were regarded as a control. C1 esterase inhibitor activity levels were significantly lower in amniotic fluid embolism patients (30.0% ± 1.8%) than in control women (62.0% ± 2.0%) (p < 0.0001). C1 esterase inhibitor activity levels in fatal amniotic fluid embolism cases (22.5% ± 3.4%) were significantly lower than those in nonfatal amniotic fluid embolism cases (32.0% ± 2.1%) (p < 0.05).
  
  
  CONCLUSIONS
  These results demonstrated that low C1 esterase inhibitor activity levels were closely associated with the pathogenesis of amniotic fluid embolism suggesting that C1 esterase inhibitor activity levels have potential as a prognosis factor of amniotic fluid embolism.
authors.affiliation: 1Department of Obstetrics and Gynaecology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. 2Department of Obstetrics and Gynaecology, Mie University School, Mie, Japan.
authors.forename: Naoaki
authors.initials: N
authors.lastname: Tamura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kimura
authors.forename: Mustari
authors.initials: M
authors.lastname: Farhana
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Uchida
authors.forename: Kazunao
authors.initials: K
authors.lastname: Suzuki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sugihara
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Itoh
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
authors.forename: Naohiro
authors.initials: N
authors.lastname: Kanayama
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D050718:Complement C1 Inhibitor Protein / Q000378:metabolism*; D004619:Embolism, Amniotic Fluid / Q000175:diagnosis / Q000378:metabolism* / Q000401:mortality; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000378:metabolism* / Q000401:mortality; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies
chemical_list: D050718:Complement C1 Inhibitor Protein