title: Value of fibrinogen in cases of maternal death related to amniotic fluid embolism.
abstract: BACKGROUND
  This study aimed to investigate the rate of coagulopathy progression in amniotic fluid embolism (AFE), using the level of fibrinogen.
  
  
  METHODS
  We examined all cases of maternal death (46 cases) related to AFE between 2010 and 2013 in Japan (total number of deliveries: 4,291,459). Fibrinogen, blood loss from AFE onset to fibrinogen measurement, and time from onset to fibrinogen measurement were investigated. The correlations of fibrinogen with time from onset to fibrinogen measurement and blood loss at fibrinogen measurement were analyzed.
  
  
  RESULTS
  Fibrinogen was undetectable (less than 50 mg/dL) in 14 cases (93%) and 65 mg/dL in one case (7%). All the cases involving not less than 1000 mL of blood loss or within 60 min from onset to fibrinogen measurement demonstrated low levels of fibrinogen.
  
  
  CONCLUSIONS
  Coagulopathy in AFE was not directly proportional to bleeding. Furthermore, coagulopathy in AFE developed in a remarkably short length of time. If AFE is suspected, fibrinogen level should be measured rapidly for favoring a more AFE to decrease the risk of death from AFE. And, rapid treatment of coagulopathy can help reduce mortality from AFE.
authors.affiliation: a Department of Obstetrics and Gynecology , Mie University Faculty of Medicine , Mie , Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: b Department of Obstetrics and Gynecology , Sakakibara Heart Institute , Tokyo , Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Katsuragi
authors.affiliation: a Department of Obstetrics and Gynecology , Mie University Faculty of Medicine , Mie , Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Osato
authors.affiliation: c Department of Obstetrics and Gynecology , St. Marianna University School of Medicine , Kawasaki , Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Hasegawa
authors.affiliation: d Department of Obstetrics and Gynecology , Toho University Omori Medical Center , Tokyo , Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nakata
authors.affiliation: e Division of Perinatology , Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital , Hamamatsu , Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Murakoshi
authors.affiliation: f Division of Maternal Fetal Medicine and Gynecology , National Cerebral and Cardiovascular Center , Osaka , Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Yoshimatsu
authors.affiliation: g Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Sekizawa
authors.affiliation: h Department of Obstetrics and Gynecology , Hamamatsu University School of Medicine , Hamamatsu , Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Kanayama
authors.affiliation: i Ishiwata Obstetrics and Gynecology Hospital , Ibaraki , Japan.
authors.forename: Isamu
authors.initials: I
authors.lastname: Ishiwata
authors.affiliation: a Department of Obstetrics and Gynecology , Mie University Faculty of Medicine , Mie , Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis / Q000378:metabolism; D004619:Embolism, Amniotic Fluid / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D005340:Fibrinogen / Q000032:analysis* / Q000378:metabolism; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D007564:Japan / Q000453:epidemiology; D063130:Maternal Death / Q000517:prevention & control; D008428:Maternal Mortality; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006490:Hemostatics; D005340:Fibrinogen
keywords: Coagulopathy; amniotic fluid embolism; fibrinogen