ABSTRACT
Cytologic findings of amniotic fluid material (AFM) in pulmonary arterial blood (PAB)
of survivors of amniotic fluid embolism (AFE) are assumed to be pathologic. However,
no cytologic studies of central blood from patients without clinical AFE have been
reported. To address this question PAB samples from peripartum patients without clinical
AFE were examined for the presence and extent of AFM (including squames, mucin, and
lanugo hair). Ten samples were obtained from five patients. All patients had at least
one sample postpartum. Peripheral blood from a nonpregnant adult female control was
processed similarly. Results were compared to a PAB sample from a patient with clinical
AFE. The patient with clinical AFE had many squames, clumps of lanugo hair, and mucin
in one sample. In six of ten study samples, there were squames, accompanied in two
cases by lanugo hair or trophoblast. In nine of ten samples there was mucin. There
appeared to be no difference in cytologic findings in patients according to mode of
delivery or sampling time. The control blood sample was negative for amniotic fluid-like
material. AFM may be found in peripartum patients without clinical amniotic fluid
embolism. A quantitative difference was seen between the index patient and each of
our five study patients. These findings suggest that there is a quantitative continuum
of AFM transported to the central circulation in peripartum patients which may, in
part, explain the varied clinical presentations and severity of AFE.
