1/6. Case report: a fatal case of amniotic fluid embolism.A primigravida was induced for PET, the liquor was meconium stained; she was put on oxytocin in-fussion and developed hypertonic uterine action. She then had an amniotic fluid embolism which presented clinically as profound shock, dyspnoea, tachycardia, cyanosis, hypotension and pyrexia. The patient was delivered by vacuum extraction. The picture was further complicated by pulmonary oedema intravascular microcoagulation and anuria. She deteriorated rapidly and died despite treatment with double strength plasma (in the absence of fibrinogen), massive hydrocortiosone therapy, blood transfusion amd sub-total hysterectomy. Post mortem findings in the lungs confirmed amniotic fluid embolism.- - - - - - - - - - ranking = 1keywords = meconium (Clic here for more details about this article) |
2/6. Determining zinc coproporphyrin in maternal plasma--a new method for diagnosing amniotic fluid embolism.We measured the concentration of zinc coproporphyrin I (ZnCP-I), a characteristic component of meconium, in maternal plasma by fluorometry after HPLC. We obtained plasma samples from 89 women: 35 at weeks 10-40 of normal pregnancy, 41 shortly after normal delivery, 4 from patients with amniotic fluid embolism (AFE), and 9 from non-AFE patients with intra- or postpartum shock caused by genital bleeding. The plasma ZnCP-I concentration was 97 (SD 83, range 38-240) nmol/L in the AFE patients, 11 (SD 9.2) nmol/L in the non-AFE patients, 12 (SD 7.9) nmol/L during normal pregnancy, and 26 (SD 10) nmol/L shortly after normal delivery. We suggest that measuring ZnCP-I in maternal plasma by fluorometry on HPLC is a rapid, noninvasive, and sensitive method for diagnosing AFE and propose 35 nmol/L as the cutoff value for the ZnCP-I concentration in maternal plasma for the diagnosis of AFE.- - - - - - - - - - ranking = 1keywords = meconium (Clic here for more details about this article) |
3/6. amniotic fluid embolism. Three case reports with a review of the literature.amniotic fluid embolism is a catastrophic event of the intra- and early postpartum period which may also be seen with cesarean delivery and during abortions. Presenting symptomatology includes respiratory distress with cyanosis, shock, and possibly tonic-clonic seizures. DIC frequently occurs. The pathogenesis may include entry of amniotic fluid through lacerations or ruptures of the uterus or cervix, through endocervical veins and through abnormal uteroplacental sites, such as with placental abruption, placenta previa, or placenta accreta. amniotic fluid probably causes cardiovascular-respiratory symptoms by pulmonary vascular obstruction and through a vasoactive substance causing pulmonary vascular constriction. The lethality of amniotic fluid may be enhanced by a high particulate content or meconium staining. The diagnosis of amniotic fluid embolism may be made ante mortem by demonstrating amniotic fluid debris in central blood samples or expectorated sputum. Postmortem diagnosis often requires meticulous examination of the pulmonary microvasculature with the utilization of special stains. Treatment is directed towards symptoms of shock, arterial hypoxemia, and DIC. Acute renal failure may complicate the picture after shock. If the patient survives the embolic and coagulative problems, recovery is usually complete without long-term sequelae.- - - - - - - - - - ranking = 1keywords = meconium (Clic here for more details about this article) |
4/6. amniotic fluid embolism after saline amnioinfusion: two cases and review of the literature.BACKGROUND: Amnioinfusion is an intrapartum intervention with proven benefit in certain clinical situations. It is thought to be a safe treatment with few adverse effects. CASES: Two cases of fatal amniotic fluid (AF) embolism occurred in women who were treated during labor with a saline amnioinfusion. In both cases, amnioinfusion was administered after finding thick meconium staining of the AF. In addition to the amnioinfusion, common factors in these cases and three previously reported AF embolisms associated with amnioinfusion are the presence of rapid labor, meconium-stained fluid, or both. CONCLUSIONS: amniotic fluid embolism is a rare cause of maternal morbidity and mortality. It is not known whether amnioinfusion increases the rate of its occurrence in laboring patients. No change in clinical practice is warranted on the basis of these reports; however, future reports must be examined so that any common factors can be identified.- - - - - - - - - - ranking = 2keywords = meconium (Clic here for more details about this article) |
5/6. A simple, noninvasive, sensitive method for diagnosis of amniotic fluid embolism by monoclonal antibody TKH-2 that recognizes NeuAc alpha 2-6GalNAc.OBJECTIVE: The sialyl Tn structure (NeuAc alpha 2-6GalNAc alpha 1-O-Ser/Thr) recognized by monoclonal antibody TKH-2 is a characteristic component in meconium and amniotic fluid. The purpose of this study was to determine whether amniotic fluid embolism could be detected by quantification of this antigen in maternal serum by means of an assay using antimucin monoclonal antibody TKH-2. STUDY DESIGN: Sialyl Tn antigen was measured in the serum of women with meconium-stained amniotic fluid and compared with the level in those with clear amniotic fluid, as well as that in women with a clinical picture suggesting amniotic fluid embolism. The concentration of sialyl Tn antigen was determined by an immunoradiometric competitive inhibition assay. RESULTS: serum sialyl Tn antigen levels in women with meconium-stained amniotic fluid (20.3 /- 15.4 U/ml) at delivery were slightly higher than those in women with clear amniotic fluid (11.8 /- 5.6 U/ml). A significantly elevated level of sialyl Tn antigen was observed in serum of patients with amniotic fluid embolism and amniotic fluid embolism-like symptoms (105.6 /- 59.0 U/ml, p < 0.01). CONCLUSION: The method for detecting sialyl Tn antigen in the serum of patients with amniotic fluid embolism is a direct way to demonstrate the release of meconium- or amniotic fluid-derived mucin into the maternal circulation and is a simple, noninvasive, sensitive method for diagnosis of amniotic fluid embolism.- - - - - - - - - - ranking = 4keywords = meconium (Clic here for more details about this article) |
6/6. Histological diagnosis of amniotic fluid embolism by monoclonal antibody TKH-2 that recognizes NeuAc alpha 2-6GalNAc epitope.This study evaluates whether immunohistochemical staining using antibody TKH-2 is presented as a sensitive method for the histological diagnosis of amniotic fluid embolism (AFE). TKH-2 is the sensitive antibody clearly directed to sialyl Tn, NeuAc alpha 2-6GalNAc and reacts with meconium- and amniotic fluid-derived mucin-type glycoprotein. Formalin-fixed, paraffin-embedded maternal lung tissue sections were obtained from four cases of patients showing AFE, and four women uninvolved with AFE served as control. Specimens were stained using the streptavidin-biotin-immunoperoxidase method. The results of immunostaining were compared with those of hematoxylin-eosin (H&E) or a conventional alcian blue stain. Remarkable positive TKH-2 stainings were observed easily within the pulmonary vasculature in patients with AFE syndrome. AFE can be easily missed on H&E sections. Compared with TKH-2 staining, alcian blue staining also may be insufficient to show intravascular mucin in the maternal lung sections. TKH-2 immunostaining is the sensitive method to detect meconium- and amniotic fluid-derived mucin in the lung sections of patients with AFE syndrome.- - - - - - - - - - ranking = 2keywords = meconium (Clic here for more details about this article) |