1/9. amniotic fluid embolism causing catastrophic pulmonary vasoconstriction: diagnosis by transesophageal echocardiogram and treatment by cardiopulmonary bypass.BACKGROUND: amniotic fluid embolism is a rare yet often lethal peripartum complication resulting from rapid cardiovascular collapse. Progress toward a better understanding of this entity has failed to identify either the underlying hemodynamic pathophysiology or an effective evidence-based treatment. CASE: A 45-year-old woman with a documented placenta previa experienced an amniotic fluid embolism during scheduled cesarean delivery. Transesophageal echocardiogram examination revealed catastrophic pulmonary vasoconstriction. The use of cardiopulmonary bypass, heparin, epinephrine, and high-dose steroids resulted in a successful outcome. CONCLUSION: Timely placement of transesophageal echocardiogram revealed catastrophic pulmonary vasoconstriction as the cause of circulatory collapse in a patient with amniotic fluid embolism, supporting the use of cardiopulmonary bypass as an effective intervention.- - - - - - - - - - ranking = 1keywords = placenta previa, previa, placenta (Clic here for more details about this article) |
2/9. Massive amniotic fluid embolism: diagnosis aided by emergency transesophageal echocardiography.A 36-year-old woman was hospitalized at term and in labor at 3-cm cervical dilatation. The early labor course was remarkable only for oxytocin augmentation and combined spinal-epidural analgesia. Eight hours after admission, tetanic uterine contractions ensued, followed by persistent fetal bradycardia. An emergency cesarean section was performed and a viable male infant was delivered. Intraoperatively, a placental abruption was identified, and disseminated intravascular coagulation and persistent hypotension developed despite resuscitative efforts. Transesophageal echocardiography revealed normal left ventricular contractility and gross enlargement of the right ventricle and main pulmonary trunk, consistent with acute right ventricular pressure overload and underloading of the left ventricle. Despite resuscitative efforts, the patient died three hours postoperatively. autopsy showed extensive microvascular plugging of the pulmonary capillaries by fetal cells in all lung fields. This is a rare case of amniotic fluid embolism diagnosed in part and managed pre-mortem with transesophageal echocardiography and confirmed by autopsy findings.- - - - - - - - - - ranking = 0.020611594379045keywords = placenta (Clic here for more details about this article) |
3/9. Successful pregnancy after amniotic fluid embolism: a case report.BACKGROUND: amniotic fluid embolism (AFE) has a mortality rate of 60% to 80% and accounts for approximately 10% of all maternal deaths in the united states. Although AFE is thought to be an anaphylactoid reaction, there are few reports of subsequent pregnancy after AFE. CASE: A healthy 29-year-old underwent an uncomplicated planned Caesarean section for her third pregnancy. She had a history of placental abruption with the first pregnancy and amniotic fluid embolism with the second pregnancy, for which she was treated with blood products and recovered fully. CONCLUSION: This case of a 29-year-old woman with successful subsequent pregnancy after amniotic fluid embolism and a limited number of case reports in the literature suggest that AFE is a sporadic event.- - - - - - - - - - ranking = 0.020611594379045keywords = placenta (Clic here for more details about this article) |
4/9. placenta previa and accreta complicated by amniotic fluid embolism.BACKGROUND: The simultaneous occurrence of placenta previa and placenta accreta in patients who had previous low transverse cesarean delivery is presently well established. However, the sequence of previous cesarean delivery followed by placenta previa and accreta in a patient who also experiences a premature rupture of membranes as well as amniotic fluid embolism (AFE) is a rare obstetric phenomenon. CASE: A 24-year-old woman, para 2 with two previous cesarean deliveries, at 32 weeks' gestation by last menstrual period, was admitted with premature rupture of membranes. A repeat cesarean delivery (CD) was done. Excessive hemorrhage occurred, necessitating a hysterectomy. Also, the patient developed an amniotic fluid embolism. CONCLUSION: placenta previa and placenta accreta may be observed in patients who have a previous CD scar and in whom AFE develops suddenly and unexpectedly. AFE, a condition with complex pathogenesis, presents a number of challenges, with the patient undergoing serious complications that may include massive hemorrhage, disseminated intravascular coagulopathy, and death. The obstetrician should be alert to the symptoms of AFE, and if they occur should begin prompt and aggressive treatment.- - - - - - - - - - ranking = 2.268656903148keywords = placenta previa, previa, placenta (Clic here for more details about this article) |
5/9. amniotic fluid embolism--2 case reports and a review of maternal deaths from this cause in australia.amniotic fluid embolism (AFE) is a dramatic, rare and frequently lethal complication of pregnancy. Perusal of the National health and Medical research Council reports on Maternal Deaths in the Commonwealth of australia for the years 1964-1984 (1-7) shows that there have been 1,193 maternal deaths in this 21-year period, of which 54 (4.5%) were due to AFE. This paper presents data regarding these deaths and also describes 2 cases of AFE which occurred at Caesarean section performed for placenta praevia, one of which was lethal.- - - - - - - - - - ranking = 0.020611594379045keywords = placenta (Clic here for more details about this article) |
6/9. amniotic fluid embolism in sweden, 1951-1980.amniotic fluid embolism is one of the least frequent complications of parturition, but the most dangerous of all. 38 cases of fatal amniotic fluid embolism were diagnosed in sweden during the years 1951-1980, i.e. 1 case for every 83,000 live births. The proportion of amniotic fluid embolism in maternal mortality as a whole increased from 1.2 to 16.5% during this period. Predisposing factors identified were gemini/polydyramnios, abruptio placentae, hypertonic labor, rupture of the birth canal, macrosomia, and obstetrical interventions such as administration of oxytocin and fundal pressure. The main symptoms were cardiovascular shock with right heart strain, and hemorrhage with pathologic proteolysis. Four cases of presumed amniotic fluid embolism with survival of the patient were diagnosed during the years 1972-1980--a case fatality rate of 66% (4/12).- - - - - - - - - - ranking = 0.020611594379045keywords = placenta (Clic here for more details about this article) |
7/9. 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 = 1.0618347831371keywords = placenta previa, previa, placenta (Clic here for more details about this article) |
8/9. Cord entanglement causing premature placental separation and amniotic fluid embolism. Case report.A woman died undelivered of amniotic fluid embolism. Postmortem examination showed that cord entanglement had caused premature placental separation with a marginal tear of the membranes and so opened a route of entry for amniotic fluid into the subplacental maternal venous sinuses. It is suggested that premature separation of the normally implanted placenta, associated with macro- or microscopic tears of or damage to the fetal membranes, provides a route of entry for amniotic fluid through the placental site in approximately one half of the fatal cases of amniotic fluid embolism.- - - - - - - - - - ranking = 0.16489275503236keywords = placenta (Clic here for more details about this article) |
9/9. Immunohistochemical identification of syncytiotrophoblastic cells and megakaryocytes in pulmonary vessels in a fatal case of amniotic fluid embolism.The histological diagnosis of amniotic fluid embolism (AFE) is based on finding amniotic fluid components in the pulmonary microvasculature. In addition to the distinctive constituents of AFE, placental and decidual tissue fragments as well as isolated trophoblastic cells and megakaryocytes are potentially detectable within pulmonary vessels. The identification of single syncytiotrophoblastic cells (STC), and their differentiation from circulating megakaryocytes (MK) within the lumen of small and medium-sized pulmonary vessels is difficult by classical morphological methods. In a fatal case of AFE, we have successfully detected the simultaneous presence of STC and MK in the pulmonary microvasculature by means of a panel of specific monoclonal (CD61-GpIIIa, beta-hCG) and polyclonal (FVIII-vW, hPL) antibodies. The immunohistochemical analysis for identification of STC and MK should provide more precise data on their incidence and distribution in physiological and pathological conditions as well providing new insights into their physiopathological implications and their correlation with AFE and other gynaecological complications.- - - - - - - - - - ranking = 0.020611594379045keywords = placenta (Clic here for more details about this article) |