{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T15:11:54Z","timestamp":1781277114462,"version":"3.54.1"},"reference-count":33,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T00:00:00Z","timestamp":1684108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify pulmonary\/uterine thrombus formation in amniotic fluid embolism (AFE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective, observational.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Nationwide.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Eleven autopsy cases of AFE and control cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We assessed pulmonary and uterine thrombus formation and thrombus area in AFE and pulmonary thromboembolism (PTE) as a control. The area of platelet glycoprotein IIb\/IIIa, fibrin, neutrophil elastase, citrullinated histone H3 (a neutrophil extracellular trap marker) and mast cell chymase immunopositivity was measured in 90 pulmonary emboli, 15 uterine thrombi and 14 PTE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Pathological evidence of thrombus formation and its components in AFE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Amniotic fluid embolism lung showed massive thrombus formation, with or without amniotic emboli in small pulmonary arteries and capillaries. The median pulmonary thrombus size in AFE (median, 0.012\u2009mm<jats:sup>2<\/jats:sup>; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) was significantly smaller than that of uterine thrombus in AFE (0.61\u2009mm<jats:sup>2<\/jats:sup>) or PTE (29\u2009mm<jats:sup>2<\/jats:sup>). The median area of glycoprotein IIb\/IIIa immunopositivity in pulmonary thrombi in AFE (39%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) was significantly larger than that of uterine thrombi in AFE (23%) and PTE (15%). The median area of fibrin (0%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and citrullinated histone H3 (0%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) immunopositivity in pulmonary thrombi in AFE was significantly smaller than in uterine thrombi (fibrin: 26%; citrullinated histone H3: 1.1%) and PTE (fibrin: 42%; citrullinated histone H3: 0.4%). No mast cells were identified in pulmonary thrombi.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Amniotic fluid may induce distinct thrombus formation in the uterus and lung. Pulmonary and uterine thrombi formation may contribute to cardiorespiratory collapse and\/or consumptive coagulopathy in AFE.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17532","type":"journal-article","created":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T11:30:08Z","timestamp":1684150208000},"page":"1685-1696","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Massive platelet\u2010rich thrombus formation in small pulmonary vessels in amniotic fluid embolism: An autopsy study"],"prefix":"10.1111","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5487-7594","authenticated-orcid":false,"given":"Atsushi","family":"Yamashita","sequence":"first","affiliation":[{"name":"Department of Pathology, Faculty of Medicine University of Miyazaki  Miyazaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoaki","family":"Oda","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Hamamatsu University School of Medicine  Hamamatsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murasaki","family":"Aman","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Medicine University of Miyazaki  Miyazaki Japan"},{"name":"Department of Pathology Miyazaki Prefectural Hospital  Miyazaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Wakasa","sequence":"additional","affiliation":[{"name":"Department of Pathology, Nara Hospital Kindai University  Ikoma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1422-9044","authenticated-orcid":false,"given":"Toshihiro","family":"Gi","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Medicine University of Miyazaki  Miyazaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Ide","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Hamamatsu University School of Medicine  Hamamatsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Todo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Hamamatsu University School of Medicine  Hamamatsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoaki","family":"Tamura","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Hamamatsu University School of Medicine  Hamamatsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Pathology, Faculty of Medicine, Miyazaki University Hospital University of Miyazaki  Miyazaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Itoh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Hamamatsu University School of Medicine  Hamamatsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujiro","family":"Asada","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Medicine University of Miyazaki  Miyazaki Japan"},{"name":"Department of Pathology Miyazaki Medical Association Hospital  Miyazaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,15]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.04.052"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.03.031"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.13445"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2019.100083"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1986.03370160085032"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(16)39241-9"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(67)90183-4"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(71)90276-6"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.12.225"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(85)90150-4"},{"issue":"6","key":"e_1_2_12_12_1","first-page":"901","article-title":"Amniotic fluid activates complement. 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