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Parenteau EW, Block M, Higgins D. Amniotic Fluid Embolism in a Patient Presenting for Induction of Labor for Cholestasis of Pregnancy. Cureus 2024; 16:e66097. [PMID: 39224715 PMCID: PMC11368449 DOI: 10.7759/cureus.66097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Amniotic fluid embolism (AFE) is a rare but potentially catastrophic complication during pregnancy. The most common presenting symptoms of AFE are cardiac arrest, hemodynamic instability, and profound hemorrhage. Here, we present a case of a 28-year-old female with a past medical history of anemia, gestational diabetes, hypothyroidism, anxiety, and depression, presenting for induction of labor for cholestasis of pregnancy. The labor course was complicated by sudden cardiac arrest and resuscitation, followed by an emergent bedside peri-cardiac arrest cesarean section. Subsequently, the patient developed coagulopathy, uterine atony, and bleeding from the vagina and cervix. The AFE protocol was initiated, and the care team proceeded with a hysterectomy. Supportive treatment correcting for metabolic acid-base disturbances and coagulopathies was maintained. The patient was stabilized for air transport to a higher level of care.
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Affiliation(s)
- Emma W Parenteau
- Anesthesiology, Creighton University School of Medicine, Phoenix, USA
| | - Maya Block
- Obstetrics and Gynecology, Creighton University School of Medicine, Phoenix, USA
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2
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Trieu NHK, Nguyen NN, Pham HM, Huynh DQ, Mai AT. Extracorporeal Membrane Oxygenation in Amniotic Fluid Embolism: A Systematic Review of Case Reports. ASAIO J 2024:00002480-990000000-00520. [PMID: 38985558 DOI: 10.1097/mat.0000000000002269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
Amniotic fluid embolism (AFE) is an obstetric complication that can result in acute circulatory failure during and after labor. The effectiveness of extracorporeal membrane oxygenation (ECMO) in AFE patients has not been established, especially in the context of coagulopathy. This review aims to evaluate the efficacy of ECMO support in AFE patients. We conducted a systematic review of case reports following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality assessment was performed using a standardized tool. Out of 141 studies screened, 33 studies included 79 AFE patients. The median age was 34 years, and the median gestational age was 37.5 weeks. The majority of AFE cases occurred during cesarean section delivery (55.2%), followed by labor before fetal delivery (26.7%). Extracorporeal membrane oxygenation configurations included venoarterial ECMO (81.3%) and extracorporeal cardiopulmonary resuscitation (CPR, 10.7%). The maternal survival rate was 72%, with 21.2% experiencing minor neurological sequelae and 5.8% having major neurological sequelae. Rescue ECMO to support circulation has demonstrated both safety and efficacy in managing AFE. We suggest early activation of local or mobile ECMO as soon as an AFE diagnosis is established. Further studies are needed to assess the benefits and implications of early ECMO support in AFE patients.
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Affiliation(s)
- Ngan Hoang Kim Trieu
- From the Department of Critical Care Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Nam Nhat Nguyen
- International Ph.D. Program in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Huy Minh Pham
- From the Department of Critical Care Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Dai Quang Huynh
- From the Department of Critical Care Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Anh Tuan Mai
- Department of Internal Medicine, Wayne State University, Michigan, USA
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3
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Susanu C, Harabor A, Vicoveanu P, Vasilache IA, Călin AM. Anesthetic Considerations and Outcomes in Amniotic Fluid Embolism: A Retrospective Study over a 15-Year Period. J Clin Med 2024; 13:2916. [PMID: 38792456 PMCID: PMC11122586 DOI: 10.3390/jcm13102916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: A rare and unexpected consequence of childbirth, labor, or the immediate postpartum period is amniotic fluid embolism (AFE). This study aims to identify AFE cases during or immediately after birth from anesthetic management perspectives. Secondary goals include assessing patient clinical features, obstetric care techniques, birth outcomes, and case survival. (2) Methods: A retrospective observational study assessed AFE patients hospitalized in three Romanian clinical institutions from October 2007 to April 2023. Based on the Society of Maternal-Fetal Medicine (SMFM) criteria, we diagnosed 11 AFE patients. (3) Results: AFE occurred in eight cases (73%) during peripartum, two (18%) within 30 min after placental delivery, and 1 (9%) during a scheduled cesarean surgery. Only one of six cardiorespiratory arrest patients responded to external cardiac massage, while the other five (83%) needed defibrillation. The patients received, on average, five units of red blood cells, six of fresh frozen plasma, and two of activated platelets. Six patients (55%) received factor VIIa infusions. Maternal mortality was 36.3%. Six neonates (75%) needed neonatal resuscitation, and two (25%) died on the second and third days. (4) Conclusions: AFE management necessitates a multidisciplinary approach and the incorporation of advanced life support techniques to optimize outcomes for both the mother and newborn.
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Affiliation(s)
- Carolina Susanu
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (C.S.)
| | - Anamaria Harabor
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (C.S.)
| | - Petronela Vicoveanu
- Department of Mother and Newborn Care, Faculty of Medicine and Biological Sciences, ‘Ștefan cel Mare’ University, 720229 Suceava, Romania
| | - Ingrid-Andrada Vasilache
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania;
| | - Alina-Mihaela Călin
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (C.S.)
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4
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Ehelepola NDB, Ranathunga RMDC, Abeysundara AB, Jayawardana HMRP, Nanayakkara PSK. Super-refractory status epilepticus, rhabdomyolysis, central hyperthermia and cardiomyopathy attributable to spinal anesthesia: a case report and review of literature. BMC Anesthesiol 2024; 24:132. [PMID: 38582882 PMCID: PMC10998312 DOI: 10.1186/s12871-024-02485-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/07/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND There are only six past reports of super-refractory status epilepticus induced by spinal anesthesia. None of those patients have died. Only < 15 mg of bupivacaine was administered to all six of them and to our case. Pathophysiology ensuing such cases remains unclear. CASE PRESENTATION A 27 year old gravida 2, para 1, mother at 37 weeks of gestation came to the operating theater for an elective cesarean section. She had no significant medical history other than controlled hypothyroidism and one episode of food allergy. Her current pregnancy was uneventful. Her American Society of Anesthesiologists (ASA) grade was 2. She underwent spinal anesthesia and adequate anesthesia was achieved. After 5-7 min she developed a progressive myoclonus. After delivery of a healthy baby, she developed generalized tonic clonic seizures that continued despite the induction of general anesthesia. She had rhabdomyolysis, one brief cardiac arrest and resuscitation, followed by stress cardiomyopathy and central hyperthermia. She died on day four. There were no significant macroscopic or histopathological changes in her brain that explain her super refractory status epilepticus. Heavy bupivacaine samples of the same batch used for this patient were analyzed by two specialized laboratories. National Medicines Quality Assurance Laboratory of Sri Lanka reported that samples failed to confirm United States Pharmacopeia (USP) dextrose specifications and passed other tests. Subsequently, Therapeutic Goods Administration of Australia reported that the drug passed all standard USP quality tests applied to it. Nonetheless, they have detected an unidentified impurity in the medicine. CONCLUSIONS After reviewing relevant literature, we believe that direct neurotoxicity by bupivacaine is the most probable cause of super-refractory status epilepticus. Super-refractory status epilepticus would have led to her other complications and death. We discuss probable patient factors that would have made her susceptible to neurotoxicity. The impurity in the drug detected by one laboratory also would have contributed to her status epilepticus. We propose several possible mechanisms that would have led to status epilepticus and her death. We discuss the factors that shall guide investigators on future such cases. We suggest ways to minimize similar future incidents. This is an idiosyncratic reaction as well.
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Affiliation(s)
- N D B Ehelepola
- Teaching (General) Hospital - Peradeniya, Peradeniya, Sri Lanka.
| | | | - A B Abeysundara
- Teaching (General) Hospital - Peradeniya, Peradeniya, Sri Lanka
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - P S K Nanayakkara
- Teaching (General) Hospital - Peradeniya, Peradeniya, Sri Lanka
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Oda T, Tamura N, Yata D, Oda-Kishimoto A, Itoh T, Kubota N, Suzuki Y, Kanayama N, Itoh H. A Case of Consumptive Coagulopathy Before Cardiopulmonary Failure in Amniotic Fluid Embolism and Review of Literature: A Perspective of the Latent Onset and Progression of Coagulopathy. Cureus 2024; 16:e55961. [PMID: 38601376 PMCID: PMC11004845 DOI: 10.7759/cureus.55961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Amniotic fluid embolism (AFE) induces cardiopulmonary insufficiency with consumptive coagulopathy. Previous studies reported that refractory coagulopathy has already advanced at the onset of maternal cardiovascular and/or respiratory symptoms. However, when the consumption of coagulation factors starts during the clinical course, AFE remains to be elucidated. We report an intrapartum AFE case of consumptive coagulopathy before dyspnea with hypotension developing during urgent cesarean delivery that was revealed by non-reassuring fetal heart rate tracing. The patient, a 42-year-old multiparous parturient, underwent induced labor after a premature rupture of membranes in week 39 of pregnancy. Coagulation screening was initially within the normal range. Fetal heart rate monitoring demonstrated bradycardia coincided with uterine tachysystole after three hours, which required urgent cesarean section with preoperative blood screening. The hemoglobin level was maintained at 129 g/L; however, the fibrinogen value reduced to 1.79 g/L with D-dimer elevation over 60 µg/mL. Ninety minutes later, she developed dyspnea with hypotension at suturing hysterotomy. At the end of surgery, her fibrinogen further decreased to below 0.3 g/L with prolonged prothrombin time. After vigorous intensive care, she was discharged without sequelae. Consumptive coagulopathy may initiate and progress before apparent cardiopulmonary symptoms in some AFE cases. Non-reassuring fetal heart rate tracing concomitant with abrupt uterine tachysystole and/or hypertonus may be an earlier time point for the detection and intervention of AFE-related coagulopathy.
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Affiliation(s)
- Tomoaki Oda
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, JPN
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Naoaki Tamura
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Daisuke Yata
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Ayako Oda-Kishimoto
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Toshiya Itoh
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, JPN
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Naohiro Kubota
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Yasuyuki Suzuki
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Naohiro Kanayama
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, JPN
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Hiroaki Itoh
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, JPN
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Suissa N, Czuzoj-Shulman N, Abenhaim HA. Amniotic fluid embolism: 20-year incidence and case-fatality trends in the United States. Eur J Obstet Gynecol Reprod Biol 2024; 294:92-96. [PMID: 38219609 DOI: 10.1016/j.ejogrb.2023.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To estimate incidence and case-fatality rates of amniotic fluid embolism (AFE) and to examine their temporal trends. STUDY DESIGN Population-based retrospective cohort study using the 2000-2019 Health Care Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). Annual population rates were estimated using HCUP-NIS specific weighting. Descriptive analyses and logistic regression described trends within the cohort. RESULTS Over the study period, AFE incidence rate remained stable (mean 4.9 cases/100,000 deliveries) and the case-fatality rate declined (mean 17.7 %,95 % CI 16.40-10.09). Highest AFE incidence rates and fatality rates were in women ≥ 35 years, African-Americans, and in urban-teaching hospitals. AFE mortality rates decreased among Hispanics. CONCLUSION AFE rates remained stable and fatality rates declined over time. Highest rates of AFE occurrence and death were in women who typically have greater risk of experiencing adverse obstetrical outcomes. Continued research into early diagnostic methods and effective treatments are needed to further improve AFE incidence and mortality rates.
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Affiliation(s)
- Naomi Suissa
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.
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Buda KG, Urbach J, Saxena R, Stanberry L, Benson G, Hryniewicz K. Veno-Arterial Extracorporeal Membrane Oxygenation for Amniotic Fluid Embolism: A Report From the Extracorporeal Life Support Organization Registry. ASAIO J 2024; 70:e6-e8. [PMID: 37429016 DOI: 10.1097/mat.0000000000002011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Affiliation(s)
- Kevin G Buda
- From the Minneapolis Heart Institute-Abbott Northwestern Hospital, Minneapolis, Minnesota
- Cardiology Division, Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Jonathan Urbach
- From the Minneapolis Heart Institute-Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Retu Saxena
- From the Minneapolis Heart Institute-Abbott Northwestern Hospital, Minneapolis, Minnesota
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | | | - Gretchen Benson
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Kasia Hryniewicz
- From the Minneapolis Heart Institute-Abbott Northwestern Hospital, Minneapolis, Minnesota
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8
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Trieu NHK, Pham HM, Mai AT. Initial management of acute circulatory failure in amniotic fluid embolism: A narrative review. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2023; 52:101288. [DOI: 10.1016/j.tacc.2023.101288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
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9
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Plantzas I, Tousia A, Vlachodimitropoulos D, Piagkou M, Goutas N, Tsakotos G, Triantafyllou G, Plantzas E, Sakelliadis E. The Anaphylactoid Syndrome of Pregnancy: Two Autopsy Cases. Cureus 2023; 15:e45145. [PMID: 37842488 PMCID: PMC10570657 DOI: 10.7759/cureus.45145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
The anaphylactoid syndrome of pregnancy (ASP) is a rare emergency with significant mortality and morbidity, in which the amniotic fluid and fetal cells enter the maternal circulation leading to respiratory failure, altered mental status, hypotension, and disseminated intravascular coagulation. The term ASP was recently introduced to replace the term amniotic fluid embolism since the clinical manifestations of the entity were more similar to a septic or anaphylactic shock rather than that of an embolic event. Two autopsy cases are described, regarding a 35-year-old gravida 2 para 1 and a 34-year-old gravida 1 para 0, where the cause of death was determined to be ASP.
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Affiliation(s)
- Ioannis Plantzas
- Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, GRC
| | - Athina Tousia
- Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Maria Piagkou
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Nikolaos Goutas
- Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, GRC
| | - George Tsakotos
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Evangelos Plantzas
- Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, GRC
| | - Emmanouil Sakelliadis
- Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, GRC
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10
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Shaikh N, Alhammad MF, Nahid S, Umm E A, Fatima I, Ummunnisa F, Yaqoub SA. Amniotic fluid embolism causing multiorgan embolisms and reinforces the need for point-of-care ultrasound. Qatar Med J 2023; 2023:13. [PMID: 37521090 PMCID: PMC10376761 DOI: 10.5339/qmj.2023.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/02/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Pregnant patients are at risk of several possible complications during the peripartum period. Amniotic fluid embolism (AFE) is a peripartum complication with high mortality and morbidity. The sudden entry of amniotic fluid into the maternal circulation causes a rapid and dramatic sequence of clinical events called AFE. The reported incidence of AFE after a cesarean section is around 19%, and after a normal delivery, it is 11%. AFE causing multiple embolisms is not reported in the literature, nor is the use of point-of-care ultrasound (POCUS) in the diagnosis of AFE. We report a case of AFE causing pulmonary and ovarian embolisms. CASE A 34-year-old pregnant lady had an elective lower section cesarean section (LSCS) for transverse lying and placenta previa under combined spinal and epidural anesthesia. She was gravida 3 para 2 and had regular antenatal check-ups, and she presented for her LSCS at 36 weeks of gestation. Immediately after delivery of the fetus, the patient had convulsions, cardiac arrest, and disseminated intravascular coagulopathy (DIC). Immediately, cardiopulmonary resuscitation started, and the team achieved a return of spontaneous circulation (ROSC) in 3 minutes. DIC was corrected with blood and blood products during this maneuver, and POCUS of the inferior vena cava and heart showed multiple small particles floating, thus confirming the diagnosis of AFE in this patient. The patient was transferred to the intensive care unit (ICU), intubated, and ventilated, necessitating a vasopressor infusion. Computed tomographic pulmonary angiography (CTPA) showed pulmonary embolism and ovarian vein embolism, which were managed with heparin infusion. She was hemodynamically stable and weaned from vasopressors, and the ventilator was then extubated on day 13 of ICU admission. She remained awake and in stable condition. The patient was transferred to the ward and subsequently discharged to go home on the 20th-day post-delivery. CONCLUSION AFE can be quickly diagnosed using clinical manifestations and POCUS, and it can be managed early for better patient outcomes. POCUS will show multiple smaller and a few larger amniotic fluid emboli in the heart and vena cava. These larger AFE emboli can migrate and cause multiple embolisms, requiring systemic anticoagulation.
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Affiliation(s)
- Nissar Shaikh
- Department of Anesthesia, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID ID: https://orcid.org/0000-0002-8241-7939
| | - Muhammad Fras Alhammad
- Department of Anesthesia, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID ID: https://orcid.org/0000-0002-8241-7939
| | - Seema Nahid
- Department of Anesthesia, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID ID: https://orcid.org/0000-0002-8241-7939
| | - Amara Umm E
- Apollo Medical College Hyderabad, Telangana, India
| | - Ifrah Fatima
- The University of Missouri-Kansas City (UMKC), Missouri, USA
| | | | - Slawa Abu Yaqoub
- Women's Wellness & Research Center, Hamad Medical Corporation, Doha, Qatar
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Flis W, Socha MW, Wartęga M, Cudnik R. Unexpected Uterine Rupture-A Case Report, Review of the Literature and Clinical Suggestions. J Clin Med 2023; 12:jcm12103532. [PMID: 37240638 DOI: 10.3390/jcm12103532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Women with a history of cesarean section are a high-risk group because they are likely to develop uterine rupture during their next pregnancy. Current evidence suggests that a vaginal birth after cesarean section (VBAC) is associated with lower maternal mortality and morbidity than elective repeat cesarean delivery (ERCD). Additionally, research suggests that uterine rupture can occur in 0.47% of cases of trial of labor after cesarean section (TOLAC). CASE DESCRIPTION A healthy 32-year-old woman at 41 weeks of gestation, in her fourth pregnancy, was admitted to the hospital due to a dubious CTG record. Following this, the patient gave birth vaginally, underwent a cesarean section, and successfully underwent a VBAC. Due to her advanced gestational age and favorable cervix, the patient qualified for a trial of vaginal labor (TOL). During labor induction, she displayed a pathological CTG pattern and presented symptoms such as abdominal pain and heavy vaginal bleeding. Suspecting a violent uterine rupture, an emergency cesarean section was performed. The presumed diagnosis was confirmed during the procedure-a full-thickness rupture of the pregnant uterus was found. The fetus was delivered without signs of life and successfully resuscitated after 3 min. The newborn girl of weight 3150 g had an Apgar score of 0/6/8/8 at 1, 3, 5, and 10 min. The uterine wall rupture was closed with two layers of sutures. The patient was discharged 4 days after the cesarean section without significant complications, with a healthy newborn girl. CONCLUSIONS Uterine rupture is a rare but severe obstetric emergency and can be associated with maternal and neonatal fatal outcomes. The risk of uterine rupture during a TOLAC attempt should always be considered, even if it is a subsequent TOLAC.
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Affiliation(s)
- Wojciech Flis
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland
- Department of Obstetrics and Gynecology, St. Adalbert's Hospital in Gdańsk, Copernicus Healthcare Entity, Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Maciej W Socha
- Department of Perinatology, Gynecology and Gynecologic Oncology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Łukasiewicza 1, 85-821 Bydgoszcz, Poland
- Department of Obstetrics and Gynecology, St. Adalbert's Hospital in Gdańsk, Copernicus Healthcare Entity, Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Mateusz Wartęga
- Department of Pathophysiology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland
| | - Rafał Cudnik
- Department of Obstetrics and Gynecology, St. Adalbert's Hospital in Gdańsk, Copernicus Healthcare Entity, Jana Pawła II 50, 80-462 Gdańsk, Poland
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12
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Tapaskar N, Tremblay-Gravel M, Khush KK. Contemporary Management of Cardiogenic Shock During Pregnancy. J Card Fail 2023; 29:193-209. [PMID: 36243342 DOI: 10.1016/j.cardfail.2022.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
Cardiogenic shock is the most extreme cardiovascular disease state during pregnancy. Peripartum cardiomyopathy is the most common cause of cardiogenic shock toward the end of pregnancy and in the early postpartum period. Therapy for cardiogenic shock relies on appropriate phenotyping of shock etiology, severity and ventricular predominance, which are critical in the appropriate selection of medical and mechanical therapy. Mechanical circulatory support may be used as a bridge to recovery or as definitive therapy. Intra-aortic balloon pumps, percutaneous left ventricular assist devices and venoarterial extracorporeal circulatory devices have been successfully used in pregnancy and the postpartum period. The most commonly used mechanical therapy in the pregnant patient is extracorporeal membranous oxygenation circulatory support. The use of mechanical circulatory devices in peripartum cardiomyopathy has contributed to improved survival rates in recent years. Further efforts to identify the optimal mechanical circulatory support strategy for peripartum cardiomyopathy and cardiogenic shock in the peripartum period are needed.
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Affiliation(s)
- Natalie Tapaskar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
| | | | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
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13
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Snavely C, Chan C. Resuscitation of the Obstetric Patient. Emerg Med Clin North Am 2023; 41:323-335. [PMID: 37024167 DOI: 10.1016/j.emc.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Pregnancy is a time of tremendous physiologic change and vulnerability. At any point, symptoms and complications can prompt the need for emergency care, and these can range from minor to life-threatening. Emergency physicians must be prepared to treat any of these complications, in addition to rescucitating the critically ill and injured pregnant patient. To optimally care for these patients, it is paramount to be aware of the unique physiologic changes that occur during pregnancy. The focus of this review is to discuss illnesses unique to pregnancy and additional aspects of resuscitation that must be considered when caring for a critically ill pregnant patient.
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Affiliation(s)
- Cheyenne Snavely
- Department of Medicine, University of Maryland Medical Center, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
| | - Caleb Chan
- Department of Medicine, University of Maryland Medical Center, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA
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14
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Sirbu O, Sorodoc V, Floria M, Statescu C, Sascau R, Lionte C, Petris OR, Haliga RE, Morariu PC, Tirnoveanu A, Burduloi VM, Ursulescu C, Sorodoc L. Nontrombotic Pulmonary Embolism: Different Etiology, Same Significant Consequences. J Pers Med 2023; 13:jpm13020202. [PMID: 36836436 PMCID: PMC9963227 DOI: 10.3390/jpm13020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Nontrombotic pulmonary embolism represents the embolization of different types of materials (cells, organisms, gas, foreign material) into pulmonary circulation. The disease is uncommon, and clinical presentation together with laboratory findings are nonspecific. Its pathology is usually misdiagnosed based on imaging findings as pulmonary thromboembolism, but the correct diagnosis is essential because different therapeutic approaches are required. In this context, knowledge of the risk factors associated with nontrombotic pulmonary embolism and specific clinical symptoms is fundamental. Our objective was to discuss the specific features of the most common etiologies of nontrombotic pulmonary embolism, gas, fat, amniotic fluid, sepsis and tumors, to provide assistance for a rapid and correct diagnosis. Because the most common etiologies are iatrogenic, knowledge of the risk factors could be an important tool for prevention or rapid treatment if the disease develops during different procedures. The diagnosis of nontrombotic pulmonary embolisms represent a laborious challenge, and endeavors should be made to prevent development and increase awareness of this disease.
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Affiliation(s)
- Oana Sirbu
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Victorita Sorodoc
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Correspondence: (V.S.); (C.S.)
| | - Mariana Floria
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Cristian Statescu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases “Dr. George I.M. Georgescu”, 700503 Iasi, Romania
- Correspondence: (V.S.); (C.S.)
| | - Radu Sascau
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases “Dr. George I.M. Georgescu”, 700503 Iasi, Romania
| | - Catalina Lionte
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Ovidiu Rusalim Petris
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Raluca Ecaterina Haliga
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Paula Cristina Morariu
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Andreea Tirnoveanu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Vladut Mirel Burduloi
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Corina Ursulescu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Radiology, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
| | - Laurentiu Sorodoc
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
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15
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Golzarian H, Mariam A, Shah SR, Pasley BA, Haq SH, Edgerton AR, Scherger WE, Stallkamp VL, Patel D, Laird A, Cole WC, Patel SM. Amniotic fluid embolism‐induced cardiopulmonary collapse successfully treated with combination VA‐ECMO and Impella CP. ESC Heart Fail 2022; 10:1440-1444. [PMID: 36480170 PMCID: PMC10053152 DOI: 10.1002/ehf2.14254] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/30/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Amniotic fluid embolism (AFE) is a rare but potentially fatal complication of pregnancy. Prompt and aggressive resuscitative strategies are crucial in promoting survivability. We present a case of AFE resulting in cardiopulmonary collapse and subsequent cardiac arrest where we were able to safely deliver the baby and resuscitate the mother with veno-arterial extracorporeal membrane oxygenation and Impella CP-a novel combination known as ECPELLA. We discuss the implications of this approach as a more efficacious strategy in resuscitating AFE-induced cardiogenic shock and arrest.
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Affiliation(s)
- Hafez Golzarian
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Alaha Mariam
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Sidra R. Shah
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Benjamin A. Pasley
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Syed H. Haq
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Anne R. Edgerton
- Department of General Surgery BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - William E. Scherger
- Department of Obstetrics and Gynecology BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Vanessa L. Stallkamp
- Department of Obstetrics and Gynecology BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Dennis Patel
- Department of Anesthesiology BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Amanda Laird
- Department of Critical Care Services BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - William C. Cole
- Department of Critical Care Services BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Sandeep M. Patel
- Structural Heart and Intervention Center BonSecours Mercy Health—St. Rita's Medical Center 730 West Market Street, 2K Tower Lima OH 45801 USA
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16
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Bridwell R, Long B, Montrief T, Gottlieb M. Post-abortion Complications: A Narrative Review for Emergency Clinicians. West J Emerg Med 2022; 23:919-925. [DOI: 10.5811/westjem.2022.8.57929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022] Open
Abstract
An abortion is a procedure defined by termination of pregnancy, most commonly performed in the first or second trimester. There are several means of classification, but the most important includes whether the abortion was maternally “safe” (performed in a safe, clean environment with experienced providers and no legal restrictions) or “unsafe” (performed with hazardous materials and techniques, by person without the needed skills, or in an environment where minimal medical standards are not met). Complication rates depend on the procedure type, gestational age, patient comorbidities, clinician experience, and most importantly, whether the abortion is safe or unsafe. Safe abortions have significantly lower complication rates compared to unsafe abortions. Complications include bleeding, retained products of conception, retained cervical dilator, uterine perforation, amniotic fluid embolism, misoprostol toxicity, and endometritis. Mortality rates for safe abortions are less than 0.2%, compared to unsafe abortion rates that range between 4.7-13.2%. History and physical examination are integral components in recognizing complications of safe and unsafe abortions, with management dependent upon the diagnosis. This narrative review provides a focused overview of post-abortion complications for emergency clinicians.
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Affiliation(s)
- Rachel Bridwell
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Tim Montrief
- Jackson Memorial Health System, Department of Emergency Medicine, Miami, Florida
| | - Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
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17
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Lei B, Guo M, Deng X, He S, Lu X, Wang Y, Wang L. Intraoperative cell salvage as an effective intervention for postpartum hemorrhage—Evidence from a prospective randomized controlled trial. Front Immunol 2022; 13:953334. [PMID: 36300123 PMCID: PMC9589269 DOI: 10.3389/fimmu.2022.953334] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality. Promptly recovering blood loss is critical for PPH. Intraoperative cell salvage (ICS) is a method to collect and process red blood cells (RBCs) from the blood lost during surgery and transfuse them to the patient’s circulation during or immediately after surgery. Its effectiveness in reducing the demand for allogeneic blood transfusion has been proven, but its effectiveness and safety as a sole treatment for PPH during Cesarean sections are unclear. This is particularly important for patients who cannot or do not want to accept allogeneic blood transfusion. Materials and methods In this prospective randomized controlled study, patients with high risks of PPH were randomized into the ICS group or the control group, receiving ICS or allogeneic RBC transfusion if their hemoglobin level was less than 80 g/L during operation. Data collected include clinical examination, blood cell count, hemoglobin level, coagulation function, and plasma levels of fetal hemoglobin, tissue factor, and alpha-fetoprotein before and after fetal delivery and 0, 2, and 12 h after treatment. Adverse events were recorded. Results A total of 130 patients were enrolled, aged 33 ± 1 years with a mean gestation period of 37 ± 1 week. The most common cause of Cesarean section was placenta previa, followed by twin pregnancy, scarred uterus, preeclampsia, placental abruption, fetal distress, and placenta accreta spectrum. Bleeding amount was similar between the two groups. The ICS group, compared to controls, had more efficient increases in levels of hemoglobin, RBC, and hematocrit (all p < 0.05). Coagulation function was maintained in the ICS group but reduced in controls 24 h after transfusion, indicated by significantly reduced fibrinogen level and prolonged prothrombin time (PT), thrombin time (TT), and activated partial thromboplastin time (aPTT) (all p < 0.05). There was a transient but significant decrease in plasma tissue factor and alpha-fetoprotein levels and an increase in plasma fetal hemoglobin level with ICS treatment in the postpartum period. No adverse event occurred with ICS intervention. Conclusion ICS is an effective and safe intervention for patients with a high risk of PPH during elective or emergency Cesarean section. It can effectively clear tissue factors and alpha-fetoprotein but not fetal hemoglobin.
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Affiliation(s)
- Bo Lei
- Department of Anesthesiology, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Min Guo
- Department of Anesthesiology, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Xin Deng
- Department of Anesthesiology, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Shujun He
- Department of Anesthesiology, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Xin Lu
- Clinical Laboratory, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Yunjuan Wang
- Department of Anesthesiology, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Lei Wang
- Department of Anesthesiology, Haidian Maternal and Child Health Hospital, Beijing, China
- *Correspondence: Lei Wang,
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18
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Obstetric Disorders and Critical Illness. Clin Chest Med 2022; 43:471-488. [PMID: 36116815 DOI: 10.1016/j.ccm.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this article, we discuss some of the more common obstetric-related conditions that can lead to critical illness and require management in an ICU. These include the hypertensive disorders of pregnancy, postpartum hemorrhage, hemolysis, elevated liver enzymes, and low platelet syndrome, acute fatty liver of pregnancy, amniotic fluid embolism, and peripartum cardiomyopathy. We also discuss pulmonary embolism and Covid-19. Despite not being specific to obstetric patients, pulmonary embolism is a common, life-threatening diagnosis in pregnancy with particular risks and management aspects. Covid-19 does not seem to occur with higher frequency in pregnant women, but it leads to higher rates of ICU admissions and mechanical ventilation in pregnant women than in their nonpregnant peers. Its prevalence during our current global pandemic makes it important to discuss in this article. We provide a basis for critical care physicians to be engaged in informed conversations and management in a multidisciplinary manner with other relevant providers in the care of critically ill pregnant and postpartum women.
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19
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Butov KR, Karetnikova NA, Pershin DY, Trofimov DY, Panteleev MA. Procoagulant Activity in Amniotic Fluid Is Associated with Fetal-Derived Extracellular Vesicles. Curr Issues Mol Biol 2022; 44:2710-2716. [PMID: 35735626 PMCID: PMC9221817 DOI: 10.3390/cimb44060185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
Procoagulant activity in amniotic fluid (AF) is positively correlated with phosphatidylserine (PS) and tissue factor (TF)-expressing(+) extracellular vesicles (EVs). However, it is unknown if pathological fetal conditions may affect the composition, phenotype, and procoagulant potency of EVs in AF. We sought to evaluate EV-dependent procoagulant activity in AF from pregnant people with fetuses with or without diagnosed chromosomal mutations. AF samples were collected by transabdominal amniocentesis and assessed for common karyotype defects (total n = 11, 7 healthy and 4 abnormal karyotypes). The procoagulant activity of AF was tested using a fibrin generation assay with normal pooled plasma and plasmas deficient in factors XII, XI, IX, X, V, and VII. EV number and phenotype were determined by flow cytometry with anti-CD24 and anti-TF antibodies. We report that factor-VII-, X-, or V-deficient plasmas did not form fibrin clots in the presence of AF. Clotting time was significantly attenuated in AF samples with chromosomal mutations. In addition, CD24+, TF+, and CD24+ TF+ EV counts were significantly lower in this group. Finally, we found a significant correlation between EV counts and the clotting time induced by AF. In conclusion, we show that AF samples with chromosomal mutations had fewer fetal-derived CD24-bearing and TF-bearing EVs, which resulted in diminished procoagulant potency. This suggests that fetal-derived EVs are the predominant source of procoagulant activity in AF.
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Affiliation(s)
- Kirill R. Butov
- Hemostasis Research Department, Dmitry Rogachev Pediatric Hematology and Immunology Hospital, Moscow 117997, Russia
- Laboratory of Molecular Mechanisms of Hemostasis, Center for Theoretical Problems of Physico-Chemical Pharmacology, Moscow 109029, Russia
- Correspondence: (K.R.B.); (M.A.P.)
| | - Natalia A. Karetnikova
- Institute of Reproductive Genetics, National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov, Moscow 117198, Russia; (N.A.K.); (D.Y.T.)
| | - Dmitry Y. Pershin
- Laboratory of Transplantation Immunology, Dmitry Rogachev Pediatric Hematology and Immunology Hospital, Moscow 117997, Russia;
| | - Dmitry Y. Trofimov
- Institute of Reproductive Genetics, National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov, Moscow 117198, Russia; (N.A.K.); (D.Y.T.)
| | - Mikhail A. Panteleev
- Hemostasis Research Department, Dmitry Rogachev Pediatric Hematology and Immunology Hospital, Moscow 117997, Russia
- Laboratory of Molecular Mechanisms of Hemostasis, Center for Theoretical Problems of Physico-Chemical Pharmacology, Moscow 109029, Russia
- Department of Physics, Lomonosov Moscow State University, Moscow 119234, Russia
- Correspondence: (K.R.B.); (M.A.P.)
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20
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McConnell's Sign in a Patient with Amniotic Fluid Embolism and Severe Right Ventricular Dysfunction. CASE (PHILADELPHIA, PA.) 2022; 5:354-357. [PMID: 34993362 PMCID: PMC8713000 DOI: 10.1016/j.case.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
McConnell’s sign may be an early sign of acute RV strain in amniotic fluid embolus. TTE could be considered to facilitate timely diagnosis of amniotic fluid embolus. The presence of RV dysfunction on TTE may help guide hemodynamic therapies.
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21
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Mauney L, Barth WH, Clapp MA. Association between peripartum hysterectomy and venous thromboembolism. Am J Obstet Gynecol 2022; 226:119.e1-119.e11. [PMID: 34224689 DOI: 10.1016/j.ajog.2021.06.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The risk of venous thromboembolism after delivery is modified by mode of delivery, with the risk of venous thromboembolism being higher after cesarean delivery than vaginal delivery. The risk of venous thromboembolism after peripartum hysterectomy is largely unknown. OBJECTIVE This study aimed to compare the incidence and risk of venous thromboembolism among women who had and did not have a peripartum hysterectomy. Furthermore, we sought to compare the risk of venous thromboembolism after hysterectomy with other patient, pregnancy, and delivery risk factors known to be associated with venous thromboembolism. STUDY DESIGN This was a cross-sectional study of women with delivery encounters identified in the Nationwide Readmissions Database from October 2015 to December 2017. Delivery encounters and all variables of interest were identified using the International Classification of Diseases, Tenth Revision diagnosis and procedure codes. The incidence of venous thromboembolism during delivery and rehospitalizations within 6 weeks after discharge was compared among women who had and did not have a peripartum hysterectomy. Multivariable logistic regressions were used to estimate associations between venous thromboembolism and hysterectomy, adjusted for the following characteristics: maternal age, payer at time of delivery, obesity, hypertension, diabetes mellitus, tobacco use, multifetal gestation, peripartum infection, and peripartum hemorrhage. Similarly, venous thromboembolism risk was compared by mode of delivery, including hysterectomy. Diagnoses that may have been indications for peripartum hysterectomy were identified among patients who underwent a hysterectomy and compared between those who did and did not have venous thromboembolism. Analyses used survey weights to obtain population estimates. RESULTS Of the 4,419,037 women with deliveries, 5098 (11.5 per 10,000 deliveries) underwent a hysterectomy. Moreover, 110 patients (215.8 per 10,000 deliveries) were diagnosed with venous thromboembolism after hysterectomy. The risk of venous thromboembolism was significantly higher in women who underwent a hysterectomy than in women who did not have a hysterectomy (unadjusted odds ratio, 25.1 [95% confidence interval, 20.0-31.5]; adjusted odds ratio, 11.2 [95% confidence interval, 8.7-14.5]; P<.001). Comparing the risk of venous thromboembolism by mode of delivery, the unadjusted and adjusted incidences of venous thromboembolism were 6.9 (95% confidence interval, 6.5-7.3) and 7.4 (95% confidence interval, 6.9-7.8) per 10,000 deliveries among women after vaginal delivery without peripartum hysterectomy, 12.5 (95% confidence interval, 11.8-13.1) and 11.3 (95% confidence interval, 10.7-12.0) per 10,000 deliveries after cesarean delivery without hysterectomy; and 217.2 (95% confidence interval, 169.1-265.2) and 96.9 (95% confidence interval 76.9-126.5) per 10,000 deliveries after hysterectomy, regardless of mode of delivery. Of the 110 diagnoses of venous thromboembolism with peripartum hysterectomy, 89 (81%) occurred during delivery admission. Of the remaining 21 cases, 50% occurred within the first 10 days after discharge from delivery, and 75% occurred within 25 days after discharge. CONCLUSION These findings have demonstrated that peripartum hysterectomy is associated with a markedly increased risk of venous thromboembolism in the postpartum period, even when controlling for other known risk factors for postpartum thromboembolic events. Here, the incidence of venous thromboembolism after peripartum hysterectomy (2.2%) met some guideline-based risk thresholds for routine thromboprophylaxis, potentially for at least 2 weeks after delivery. Further investigation into the role of routine venous thromboembolism prophylaxis during and after delivery is needed.
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Affiliation(s)
- Logan Mauney
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA.
| | - William H Barth
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mark A Clapp
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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22
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Ge C, Liu J, Fu Y, Jia L, Bai Y, Yang Z, Du Q. A case report of early application of veno-arterial extracorporeal membrane oxygenation in amniotic fluid embolism. Medicine (Baltimore) 2021; 100:e27896. [PMID: 34797339 PMCID: PMC8601314 DOI: 10.1097/md.0000000000027896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Amniotic fluid embolism (AFE) is a rare obstetrical complication and is a leading cause of maternal death in developed countries. Despite the development of supportive therapeutic measures, the mortality rate remains high. PATIENT CONCERNS A 38-year-old nulliparous pregnant woman, who underwent in vitro fertilization-embryo transfer, was admitted for labor at 37 weeks' gestation. Approximately 30 minutes after delivery of the placenta, the puerpera developed postpartum hemorrhage with uterine atony. Soon after, the patient experienced hypotension, repeated cardiac arrest, refectory hypoxia, and disseminated intravascular coagulopathy. DIAGNOSIS AFE is diagnosed clinically. The pregnant woman in this case fulfilled the diagnostic criteria for AFE: acute hypotension, cardiac arrest, acute hypoxia, and coagulation disorders within approximately 30 minutes after delivery of the placenta. INTERVENTIONS The patient was intubated, connected to a ventilator, and was administered a high dose of vasoactive drugs to maintain blood pressure and underwent an emergency hysterectomy. Considering the risk for recurrent cardiac arrest and severe refractory hypoxia, venoarterial extracorporeal membrane oxygenation was initiated and discontinued as soon as cardiac function was restored based on serial bedside ultrasound assessment. OUTCOMES The patient stabilized on day 7 in the intensive care unit and was transferred to the obstetrics ward and, 1 week later, was discharged with no complications. Two months later, follow-up revealed that the patient was in good condition. LESSON Serial bedside ultrasound was crucial for assessing cardiac function and optimal weaning. Timely application of venoarterial extracorporeal membrane oxygenation and weaning was significant to avoid the occurrence of complications and improve long-term outcomes.
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Affiliation(s)
- Chen Ge
- Department of Intensive Medicine, Hebei General Hospital, Shijiazhuang City, Hebei Province, P.R. China
| | - Junhang Liu
- Department of Orthopaedics Surgery, Children's Hospital of Hebei, Shijiazhuang City, Hebei Province, P.R. China
| | - You Fu
- Department of Intensive Medicine, Hebei General Hospital, Shijiazhuang City, Hebei Province, P.R. China
| | - Lijing Jia
- Department of Intensive Medicine, Hebei General Hospital, Shijiazhuang City, Hebei Province, P.R. China
| | - Yinxiang Bai
- Department of Intensive Medicine, Hebei General Hospital, Shijiazhuang City, Hebei Province, P.R. China
| | - Zhiwei Yang
- Department of Intensive Medicine, Hebei General Hospital, Shijiazhuang City, Hebei Province, P.R. China
| | - Quansheng Du
- Department of Intensive Medicine, Hebei General Hospital, Shijiazhuang City, Hebei Province, P.R. China
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23
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Himmelwright RS, Dominguez JE. Postpartum Respiratory Depression. Anesthesiol Clin 2021; 39:687-709. [PMID: 34776104 DOI: 10.1016/j.anclin.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Postpartum respiratory depression is a complex, multifactorial issue that encompasses a patient's baseline preexisting conditions, certain pregnancy-specific conditions or complications, as well as the iatrogenic element of various medications given in the peripartum period. In this review, we discuss many of these factors including obesity, sleep-disordered breathing, chronic lung disease, neuromuscular disorders, opioids, preeclampsia, peripartum cardiomyopathy, postpartum hemorrhage, amniotic fluid embolism, sepsis, acute respiratory distress syndrome (ARDS), and medications such as analgesics, sedatives, anesthetics, and magnesium. Current recommendations for screening, treatment, and prevention are also discussed.
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Affiliation(s)
| | - Jennifer E Dominguez
- Duke University Medical Center, DUMC 3094, MS#9, 2301 Erwin Road, Durham, NC 27710, USA.
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24
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Liew-Spilger AE, Sorg NR, Brenner TJ, Langford JH, Berquist M, Mark NM, Moore SH, Mark J, Baumgartner S, Abernathy MP. Viscoelastic Hemostatic Assays for Postpartum Hemorrhage. J Clin Med 2021; 10:3946. [PMID: 34501395 PMCID: PMC8432102 DOI: 10.3390/jcm10173946] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 12/15/2022] Open
Abstract
This article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. VHAs are advantageous because they assess the cumulative contribution of all components of the blood throughout the entire formation of a clot, have fast turnaround times, and are point-of-care tests that can be followed serially. Despite these advantages, VHAs are underused due to poor understanding of correct technique and result interpretation, a paucity of widespread standardization, and a lack of large clinical trials. These VHAs can also be used in cases of uterine atony, preeclampsia, acute fatty liver of pregnancy, amniotic fluid embolism, placental abruption, genital tract trauma, surgical trauma, and inherited and prepartum acquired coagulopathies. There exists an immediate need for a point-of-care test that can equip obstetricians with rapid results on developing coagulopathic states. The use of VHAs in predicting and treating PPH, although in an incipient state, can fulfill this need.
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Affiliation(s)
- Alyson E. Liew-Spilger
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA;
| | - Nikki R. Sorg
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA; (N.R.S.); (N.M.M.); (J.M.)
| | - Toby J. Brenner
- Division of Natural Sciences, Indiana Wesleyan University, Marion, IN 46953, USA;
| | - Jack H. Langford
- College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA;
| | - Margaret Berquist
- College of Science, University of Notre Dame, Notre Dame, IN 46556, USA;
| | - Natalie M. Mark
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA; (N.R.S.); (N.M.M.); (J.M.)
| | - Spencer H. Moore
- Marian University College of Osteopathic Medicine, Indianapolis, IN 46222, USA;
| | - Julie Mark
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN 46617, USA; (N.R.S.); (N.M.M.); (J.M.)
| | - Sara Baumgartner
- Department of Obstetrics and Gynecology, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Mary P. Abernathy
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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Adachi M, Adachi T, Fujita T, Hyuga S, Onishi Y, Okutomi T. Venoarterial extracorporeal membrane oxygenation as an early treatment for amniotic fluid embolism with cardiac arrest: A case report. J Obstet Gynaecol Res 2021; 47:3374-3378. [PMID: 34132000 DOI: 10.1111/jog.14880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 04/02/2021] [Accepted: 05/29/2021] [Indexed: 11/28/2022]
Abstract
Amniotic fluid embolism (AFE) is a rare but fatal obstetric complication, characterized by sudden cardiovascular collapse, respiratory failure, and disseminated intravascular coagulation. Maternal mortality associated with AFE is high, making early recognition and prompt treatment important. In AFE with cardiac arrest, survival following acute cardiopulmonary dysfunction is crucial. In recent years, venoarterial extracorporeal membrane oxygenation (VA-ECMO) has attracted attention as an aggressive treatment for AFE with cardiac arrest. A 40-year-old woman experienced sudden cardiac arrest due to AFE during cesarean section. Cardiopulmonary resuscitation and VA-ECMO (also called percutaneous cardiopulmonary support) were initiated early. Finally, she recovered without any complications. VA-ECMO can provide temporary respiratory and hemodynamic support until cardiopulmonary function improves after a few days in intensive care. VA-ECMO should be considered as an early treatment for AFE with cardiac arrest.
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Affiliation(s)
- Mariko Adachi
- Division of Obstetric Anesthesia, Center for Perinatal Care, Child Health and Development, Kitasato University Hospital, Sagamihara, Japan
| | - Takeshi Adachi
- Department of Anesthesiology, Kitasato University, School of Medicine, Sagamihara, Japan
| | - Tomoe Fujita
- Division of Obstetric Anesthesia, Center for Perinatal Care, Child Health and Development, Kitasato University Hospital, Sagamihara, Japan
| | - Shunsuke Hyuga
- Division of Obstetric Anesthesia, Center for Perinatal Care, Child Health and Development, Kitasato University Hospital, Sagamihara, Japan
| | - Yoko Onishi
- Department of Obstetrics and Gynecology, Center for Perinatal Care, Child Health and Development, Kitasato University Hospital, Sagamihara, Japan
| | - Toshiyuki Okutomi
- Division of Obstetric Anesthesia, Center for Perinatal Care, Child Health and Development, Kitasato University Hospital, Sagamihara, Japan
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26
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Ren F, Huang W, Luo L, Zhou J, Huang D, Tang L. Amniotic fluid and pulmonary emboli in a patient with SLE and a twin gestation. Rheumatology (Oxford) 2021; 59:e107-e108. [PMID: 32596716 DOI: 10.1093/rheumatology/keaa285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Feifeng Ren
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenhan Huang
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Luo
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Zhou
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dongmei Huang
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Tang
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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27
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Correa-de-Araujo R, Yoon SS(S. Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age. J Womens Health (Larchmt) 2021; 30:160-167. [PMID: 33185505 PMCID: PMC8020515 DOI: 10.1089/jwh.2020.8860] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Although the influence of advanced maternal age (AMA) and delayed childbearing on adverse maternal and perinatal outcomes has been studied extensively, no universal consensus on the definition of AMA exists. This terminology currently refers to the later years of a woman's reproductive life span and generally applies to women age ≥35 years. AMA increases the risk of pregnancy complications, including ectopic pregnancy, spontaneous abortion, fetal chromosomal abnormalities, congenital anomalies, placenta previa and abruption, gestational diabetes, preeclampsia, and cesarean delivery. Such complications could be the cause of preterm birth and increase the risk of perinatal mortality. For women who have a chronic illness, pregnancy may lead to additional risk that demands increased monitoring or surveillance. The management of pregnant women of AMA requires understanding the relationship between age and preexisting comorbidities. The outcomes from pregnancy in AMA may have a negative impact on women's health as they age because of both the changes from the pregnancy itself and the increased risk of pregnancy-related complications. Postpartum depression affects women of AMA at higher rates. Links between preeclampsia and the risk of future development of cardiovascular disease require follow-up surveillance. The association between hypertensive pregnancy disorders and cognitive and brain functions needs further investigation of sex-specific risk factors across the life span. Educating providers and women of AMA is crucial to facilitate clinical decision making and such education should consider cultural influences, risk perception, and women's health literacy, as well as providers' biases and system issues.
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Affiliation(s)
- Rosaly Correa-de-Araujo
- Division of Geriatrics and Clinical Gerontology, U.S. Department of Health and Human Services, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Sung Sug (Sarah) Yoon
- Division of Extramural Science Programs, U.S. Department of Health and Human Services, National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
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28
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Piersanti V, Consalvo F, Signore F, Del Rio A, Zaami S. Surrogacy and "Procreative Tourism". What Does the Future Hold from the Ethical and Legal Perspectives? MEDICINA (KAUNAS, LITHUANIA) 2021; 57:47. [PMID: 33429930 PMCID: PMC7827900 DOI: 10.3390/medicina57010047] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/17/2020] [Accepted: 01/05/2021] [Indexed: 01/22/2023]
Abstract
Background and objectives: To explore the ethical and legal complexities arising from the controversial issue of surrogacy, particularly in terms of how they affect fundamental rights of children and parents. Surrogacy is a form of medically-assisted procreation (MAP) in which a woman "lends" her uterus to carry out a pregnancy on behalf of a third party. There are pathological conditions, such as uterine agenesis or hysterectomy outcomes, that may prevent prospective mothers from becoming pregnant or carry a pregnancy to term; such patients may consider finding a surrogate mother. Many issues relating to surrogacy remain unresolved, with significant disagreements and controversy within the scientific community and public opinion. There are several factors called into play and multiple parties and stakeholders whose objectives and interests need to somehow be reconciled. First and foremost, the authors contend, it is essential to prioritize and uphold the rights of children born through surrogacy and heterologous MAP. Materials and methods: To draw a parallel between Italy and the rest of the world, the legislation in force in twelve European countries was analyzed, eleven of which are part of the European Union (France, Germany, Italy, Spain, Greece, Netherlands, Belgium, Denmark, Lithuania, Czech Republic and Portugal) and three non-members of the same (United Kingdom, Ukraine and Russia), as well as that of twelve non-European countries considered exemplary (United States, Canada, Australia, India, China, Thailand, Israel, Nigeria and South Africa); in particular, legislative sources and legal databases were drawn upon, in order to draw a comparison with the Italian legislation currently in force and map out the evolution of the Italian case law on the basis of the judgments issued by Italian courts, including the Constitutional and Supreme Courts and the European Court of Human Rights (ECHR); search engines such as PubMed and Google Scholar were also used, by entering the keywords "surrogacy" and "surrogate motherhood", to find scientific articles concerning assisted reproduction techniques with a close focus on surrogacy. Results: SM is a prohibited and sanctioned practice in Italy; on the other hand, it is allowed in other countries of the world, which leads Italian couples, or couples from other countries where it is banned, to often contact foreign centers in order to undertake a MAP pathway which includes surrogacy; in addition, challenges may arise from the legal status of children born through surrogacy abroad: to date, in most countries, there is no specific legislation aimed at regulating their legal registration and parental status. Conclusion: With reference to the Italian context, despite the scientific and legal evolution on the subject, a legislative intervention aimed at filling the regulatory gaps in terms of heterologous MAP and surrogacy has not yet come to fruition. Considering the possibility of "fertility tourism", i.e., traveling to countries where the practice is legal, as indeed already happens in a relatively significant number of cases, the current legislation, although integrated by the legal interpretation, does not appear to be effective in avoiding the phenomenon of procreative tourism. Moreover, to overcome some contradictions currently present between law 40 and law 194, it would be appropriate to outline an organic and exhaustive framework of rules, which should take into account the multiplicity of interests at stake, in keeping with a fair and sustainable balance when regulating such practices.
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Affiliation(s)
- Valeria Piersanti
- Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Sapienza University, 00198 Rome, Italy; (V.P.); (F.C.); (S.Z.)
| | - Francesca Consalvo
- Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Sapienza University, 00198 Rome, Italy; (V.P.); (F.C.); (S.Z.)
| | - Fabrizio Signore
- Obstetrics and Gynecology Department, Sant’Eugenio Hospital, 00144 Rome, Italy;
| | - Alessandro Del Rio
- Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Sapienza University, 00198 Rome, Italy; (V.P.); (F.C.); (S.Z.)
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Sapienza University, 00198 Rome, Italy; (V.P.); (F.C.); (S.Z.)
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29
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Opaskar A, Massaquoi R, Sila C. Stroke in pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:283-293. [PMID: 33632448 DOI: 10.1016/b978-0-12-819814-8.00032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Stroke in pregnancy is rare and has a wide range of etiologies and implications on stroke management that differ from nonpregnant individuals. The highest risk of stroke is during the third trimester and puerperium period, where hypertensive disorders of pregnancy occur; however, stroke can occur at any point during pregnancy. In this chapter, we will provide an overview of the epidemiology of stroke in pregnancy and then review the specific etiologies of ischemic and hemorrhagic stroke as they relate to pregnant women. Finally, we discuss the process of acute stroke evaluation in pregnancy and the management of women after stroke with regard to long-term risk factors, medications, and implications in future pregnancies. Throughout the chapter, we highlight relevant guidelines from the American Heart Association and American Stroke Association and key literature on stroke in pregnancy.
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Affiliation(s)
- Amanda Opaskar
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Reyanna Massaquoi
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Cathy Sila
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
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30
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Abstract
Care of the critically ill pregnant patient is anxiety-provoking for those unprepared, as the emergency physician must consider not only the welfare of the immediate patient, but of the fetus as well. Familiarity with the physiologic changes of pregnancy and how they affect clinical presentation and management is key. Although some medications may be safer in pregnancy than others, stabilizing the pregnant patient is paramount. Emergency physicians should target pregnancy-specific oxygen and ventilation goals and hemodynamics and should be prepared to perform a perimortem cesarean section, should the mother lose pulses, to increase chances for maternal and fetal survival.
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Affiliation(s)
- Kami M Hu
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Department of Internal Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
| | - Aleta S Hong
- Department of Internal Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. https://twitter.com/hong_aleta
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31
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Pu Y, Liu X, Wang Y, Meng X, Jing J, Zou X, Pan Y, Wang A, Zhao X, Johnston SC, Wang Y, Atchaneeyasakul K, Liebeskind DS, Liu L. Higher early recurrence risk and potential benefit of dual antiplatelet therapy for minor stroke with watershed infarction: subgroup analysis of CHANCE. Eur J Neurol 2020; 27:800-808. [PMID: 31997490 DOI: 10.1111/ene.14156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 01/17/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Y. Pu
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
| | - X. Liu
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Y. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - X. Meng
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - J. Jing
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - X. Zou
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Y. Pan
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - A. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - X. Zhao
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - S. C. Johnston
- Dell Medical School University of Texas at Austin TX USA
| | - Y. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | | | | | - L. Liu
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
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32
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Gusev EY, Zotova NV. Cellular Stress and General Pathological Processes. Curr Pharm Des 2020; 25:251-297. [PMID: 31198111 DOI: 10.2174/1381612825666190319114641] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/13/2019] [Indexed: 02/06/2023]
Abstract
From the viewpoint of the general pathology, most of the human diseases are associated with a limited number of pathogenic processes such as inflammation, tumor growth, thrombosis, necrosis, fibrosis, atrophy, pathological hypertrophy, dysplasia and metaplasia. The phenomenon of chronic low-grade inflammation could be attributed to non-classical forms of inflammation, which include many neurodegenerative processes, pathological variants of insulin resistance, atherosclerosis, and other manifestations of the endothelial dysfunction. Individual and universal manifestations of cellular stress could be considered as a basic element of all these pathologies, which has both physiological and pathophysiological significance. The review examines the causes, main phenomena, developmental directions and outcomes of cellular stress using a phylogenetically conservative set of genes and their activation pathways, as well as tissue stress and its role in inflammatory and para-inflammatory processes. The main ways towards the realization of cellular stress and its functional blocks were outlined. The main stages of tissue stress and the classification of its typical manifestations, as well as its participation in the development of the classical and non-classical variants of the inflammatory process, were also described. The mechanisms of cellular and tissue stress are structured into the complex systems, which include networks that enable the exchange of information with multidirectional signaling pathways which together make these systems internally contradictory, and the result of their effects is often unpredictable. However, the possible solutions require new theoretical and methodological approaches, one of which includes the transition to integral criteria, which plausibly reflect the holistic image of these processes.
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Affiliation(s)
- Eugeny Yu Gusev
- Laboratory of the Immunology of Inflammation, Institute of Immunology and Physiology, Yekaterinburg, Russian Federation
| | - Natalia V Zotova
- Laboratory of the Immunology of Inflammation, Institute of Immunology and Physiology, Yekaterinburg, Russian Federation.,Department of Medical Biochemistry and Biophysics, Ural Federal University named after B.N.Yeltsin, Yekaterinburg, Russian Federation
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33
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Amniotic Fluid Embolism Treated with Veno-Arterial Extracorporeal Membrane Oxygenation. Case Rep Crit Care 2019; 2019:4589636. [PMID: 31934458 PMCID: PMC6942779 DOI: 10.1155/2019/4589636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 11/17/2022] Open
Abstract
Amniotic fluid embolism (AFE) is an extremely rare yet fatal obstetric emergency. AFE presents as sudden cardiovascular collapse after a breach of maternal-fetal membranes and is often complicated by severe coagulopathy. We present a case where an AFE was treated with veno-arterial extracorporeal membrane oxygenation (ECMO) to help overcome the acute cardiopulmonary insult. The use of echocardiography proved to be an invaluable tool to help guide treatment and optimal duration of ECMO in the face of severe coagulopathy.
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34
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Knisley J, DeBruyn E, Weaver M. Management of Extracorporeal Membrane Oxygenation for Obstetric Patients: Concerns for Critical Care Nurses. Crit Care Nurse 2019; 39:e8-e15. [PMID: 30936139 DOI: 10.4037/ccn2019620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Critical care nurses are faced with many challenges, and one that is particularly stressful is caring for obstetric patients. This care can become more complex when the obstetric patient requires extracorporeal membrane oxygenation. It is imperative that critical care nurses have knowledge about this unique population, the expected physical changes of pregnancy, and the management of extracorporeal membrane oxygenation. Obstetric patients present unique challenges, and care is focused on the woman and her family. The purpose of this paper is to provide information for critical care nurses regarding care of obstetric patients who receive extracorporeal membrane oxygenation.
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Affiliation(s)
- Jody Knisley
- Jody Knisley is a nurse practitioner at The Ohio State University Wexner Medical Center, Columbus, Ohio.,Erin DeBruyn is a women's health nurse practitioner in a private obstetrics and gynecology practice in Nashville, Tennessee.,Michelle Weaver is a nurse practitioner at The Ohio State University Wexner Medical Center
| | - Erin DeBruyn
- Jody Knisley is a nurse practitioner at The Ohio State University Wexner Medical Center, Columbus, Ohio.,Erin DeBruyn is a women's health nurse practitioner in a private obstetrics and gynecology practice in Nashville, Tennessee.,Michelle Weaver is a nurse practitioner at The Ohio State University Wexner Medical Center
| | - Michelle Weaver
- Jody Knisley is a nurse practitioner at The Ohio State University Wexner Medical Center, Columbus, Ohio. .,Erin DeBruyn is a women's health nurse practitioner in a private obstetrics and gynecology practice in Nashville, Tennessee. .,Michelle Weaver is a nurse practitioner at The Ohio State University Wexner Medical Center.
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35
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Kayaalti S. [Intermittent loss of consciousness during cesarean section under spinal anesthesia: a case report]. Rev Bras Anestesiol 2019; 69:631-634. [PMID: 31796299 DOI: 10.1016/j.bjan.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/02/2019] [Accepted: 09/07/2019] [Indexed: 10/25/2022] Open
Abstract
Loss of consciousness during spinal anesthesia is a rare but scary complication. This complication is generally related to severe hypotension and bradycardia, but in this case, the loss of consciousness occurred in a hemodynamically stable parturient patient. We present a 31 years-old patient who underwent an emergency cesarean section. She lost consciousness and had apnea that started 10 minutes after successful spinal anesthesia and repeated three times for a total of 25 minutes, despite the stable hemodynamics of the patient. The case was considered a subdural block, and the patient was provided with respiratory support. The subdural block is expected to start slowly (approximately 15-20minutes), but in this case, after about 10 minutes of receiving anesthesia, the patient suddenly had a loss of consciousness. After the recovery of consciousness and return of spontaneous respiration, the level of a sensory block of the patient, who was cooperative and oriented, was T4. There were motor blocks in both lower extremities. Four hours after intrathecal injection, both the sensory and motor blocks ended, and she was discharged two days later with no complications. Hence, patients who receive spinal anesthesia should be closely observed for any such undesirable complications.
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Affiliation(s)
- Selda Kayaalti
- Develi Public Hospital, Department of Anesthesiology and Reanimation, Kayseri, Turquia.
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36
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Greco PS, Day LJ, Pearlman MD. Guidance for Evaluation and Management of Blunt Abdominal Trauma in Pregnancy. Obstet Gynecol 2019; 134:1343-1357. [PMID: 31764749 DOI: 10.1097/aog.0000000000003585] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Blunt abdominal trauma is the leading type of traumatic injury in pregnancy, with motor vehicle crashes, falls, and assault being the most common etiologies. Several adverse outcomes can occur in pregnancy, including placental abruption, preterm labor and preterm delivery, uterine rupture, and pelvic fracture. Understanding and integration of key anatomic and physiologic changes in pregnancy are key when evaluating a pregnant trauma patient. Pregnant women should be managed in a medical center with the ability to provide adequate care to both trauma patients-the pregnant woman and fetus. Multiple clinical providers are usually involved in the care of pregnant trauma patients, but obstetric providers should play a central role in the evaluation and management of a pregnant trauma patient given their unique training, knowledge, and clinical skills. An algorithm for management of trauma in pregnancy should be used at all sites caring for pregnant women. An alignment of policies within each system optimizes appropriate triage, integration of care, management, and monitoring of pregnant trauma patients and their fetuses. Ensuring effective protocols for prehospital and hospital treatment, as well as thorough training of involved health care providers, is essential in ensuring that optimal care is provided.
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Affiliation(s)
- Patricia S Greco
- University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, Michigan
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37
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Johnson AL, Reader JR. Pulmonary amniotic fluid embolism in a rhesus macaque (Macaca mulatta). J Med Primatol 2019; 49:60-62. [PMID: 31742695 DOI: 10.1111/jmp.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/16/2019] [Accepted: 10/26/2019] [Indexed: 12/01/2022]
Abstract
A pregnant female rhesus macaque died spontaneously during stage two labor. Gross and histopathologic findings included severe pulmonary edema, with low numbers of blood vessels containing pale basophilic mucinous material (Alcian Blue positive and PTAH negative), consistent with intravascular amniotic fluid-derived mucin resulting in pulmonary amniotic fluid embolism.
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Affiliation(s)
- Amanda L Johnson
- California National Primate Research Center, Anatomic and Clinical Pathology Service, University of California, Davis, California
| | - J Rachel Reader
- California National Primate Research Center, Anatomic and Clinical Pathology Service, University of California, Davis, California
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38
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Kayaalti S. Intermittent loss of consciousness during cesarean section under spinal anesthesia: a case report. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2019. [PMID: 31796299 PMCID: PMC9391916 DOI: 10.1016/j.bjane.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Loss of consciousness during spinal anesthesia is a rare but scary complication. This complication is generally related to severe hypotension and bradycardia, but in this case, the loss of consciousness occurred in a hemodynamically stable parturient patient. We present a 31 years-old patient who underwent an emergency cesarean section. She lost consciousness and had apnea that started 10 minutes after successful spinal anesthesia and repeated three times for a total of 25 minutes, despite the stable hemodynamics of the patient. The case was considered a subdural block, and the patient was provided with respiratory support. The subdural block is expected to start slowly (approximately 15–20 minutes), but in this case, after about 10 minutes of receiving anesthesia, the patient suddenly had a loss of consciousness. After the recovery of consciousness and return of spontaneous respiration, the level of a sensory block of the patient, who was cooperative and oriented, was T4. There were motor blocks in both lower extremities. Four hours after intrathecal injection, both the sensory and motor blocks ended, and she was discharged two days later with no complications. Hence, patients who receive spinal anesthesia should be closely observed for any such undesirable complications.
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Affiliation(s)
- Selda Kayaalti
- Develi Public Hospital, Department of Anesthesiology and Reanimation, Kayseri, Turquia.
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39
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Brennan AP, Eskander A, Zois J, Burns AT. An Unusual Case of Shock Following an Elective Caesarean Delivery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:88-91. [PMID: 31324480 DOI: 10.1016/j.jogc.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The differential diagnosis of peripartum chest pain and cardiogenic shock is broad and includes pulmonary embolism, amniotic fluid embolism, peripartum and Takotsubo cardiomyopathy, myocardial infarction, and anaesthetic complications. CASE A 31-year-old woman with Addison's disease underwent an elective caesarean section that was complicated by chest pain and cardiogenic shock. After initial resuscitation, she was transferred to a tertiary hospital, and urgent transthoracic echocardiography revealed severe systolic dysfunction. She was treated with an increased dose of hydrocortisone and intravenous furosemide and improved. Follow-up imaging showed improvement of left ventricular systolic function. CONCLUSION In patients with cardiogenic shock after delivery, early transthoracic echocardiography is a non-invasive tool that can rapidly narrow the differential diagnosis.
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Affiliation(s)
| | - Alex Eskander
- Mercy Hospital for Women, Heidelberg, Melbourne, Australia
| | - John Zois
- Department of Anaesthesia, Northern Health Melbourne, Australia
| | - Andrew T Burns
- Department of Cardiology, St Vincent's Hospital Melbourne, Australia
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Abstract
Obstetric emergencies often require intensive care intervention. Amniotic fluid embolism is a rare, unpredictable, and often catastrophic complication of pregnancy that is suspected in a woman who experiences cardiac arrest after a cesarean section. The condition occurs in approximately 1 in 40 000 births and has an average case-fatality rate of 16%. This complication may result from activation of an inflammatory response to fetal tissue in the maternal circulation. Risk factors may include maternal age over 35 years and conditions in which fluid can exchange between the maternal and fetal circulations. The presentation is abrupt, with profound cardiovascular and respiratory compromise, encephalopathy, fetal distress, and disseminated intravascular coagulopathy. Diagnosis is by exclusion and clinical presentation. Treatment is supportive, with a focus on reversal of hypoxia and hypotension, delivery of the fetus, and correction of coagulopathy. Staff debriefing and psychological support for the woman and family are vital.
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Affiliation(s)
- Anne-Marie McBride
- Anne-Marie McBride is Clinical Nurse, Intensive Care, Calvary North Adelaide Hospital, 23 Strangways Terrace, North Adelaide, 5006 Australia
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Atypical Amniotic Fluid Embolism Managed with a Novel Therapeutic Regimen. Case Rep Obstet Gynecol 2017; 2017:8458375. [PMID: 29430313 PMCID: PMC5753013 DOI: 10.1155/2017/8458375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 09/26/2017] [Accepted: 11/19/2017] [Indexed: 01/08/2023] Open
Abstract
Amniotic fluid embolism (AFE) is the second leading cause of maternal mortality in the USA with an incidence of 1 : 15,200 births. The case fatality rate and perinatal mortality associated with AFE are 13–30% and 9–44%, respectively. This rare but devastating complication can be difficult to diagnose as many of the early signs and symptoms are nonspecific. Compounding this diagnostic challenge is a lack of effective treatment regimens which to date are mostly supportive. We present the case of a 26-year-old woman who suffered from suspected AFE and was successfully treated with the novel regimen of Atropine, Ondansetron, and Ketorolac (A-OK). The authors acknowledge that this case does not meet the new criteria proposed, by Clark in 2016, but feel that it is important to share this case report, due to dramatic patient response to the provided supportive therapy presented in this case report. We hope this case report will prompt further research into this novel approach to treating AFE with Atropine, Ondansetron, and Ketorolac.
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Skolnik S, Ioscovich A, Eidelman LA, Davis A, Shmueli A, Aviram A, Orbach-Zinger S. Anesthetic management of amniotic fluid embolism -- a multi-center, retrospective, cohort study. J Matern Fetal Neonatal Med 2017; 32:1262-1266. [PMID: 29166810 DOI: 10.1080/14767058.2017.1404024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Amniotic fluid embolism (AFE) is a rare and potentially lethal obstetric complication, commonly occurring during labor, delivery, or immediately postpartum. There is a paucity of data regarding incidence, risk factors, and clinical management. Our primary objective in this study was to evaluate clinical presentation of AFE and delineate anesthesia management of these cases. METHODS This 10 years retrospective multi-center cohort study was performed in five tertiary university-affiliated medical centers, between the years 2005 and 2015. All documented cases of AFE identified according to the ICD guidelines were reviewed manually to determine eligibility for AFE according to Clark's criteria. All cases confirming Clark's diagnosis were included in the cohort. RESULTS Throughout the study period, 20 cases of AFE were identified, with an incidence of 4.1 per 100,000 births. Average age at presentation was 35 ± 5 years. Seventy percent of cases presented during vaginal delivery, 20% occurred throughout a cesarean delivery, and 10% occurred during a dilation and evacuation procedure. The most common presenting symptom was sudden loss of consciousness in 12 parturients (66.7%), fetal bradycardia in 11 parturients (55%), and shortness of breath in 10 parturients (50%). Perimortem cesarean section was performed in 55% of cases, although only one case was performed in the delivery suite, while all others were performed in the operating room. Echocardiography was performed in 60% of the cases and all were pathological. Furthermore, 20% of cases were connected to an extracorporeal membrane oxygenation machine. There was a 15% mortality rate of 15%. A further 15% suffered major neurological disability, 25% suffered minor neurological morbidity, and 45% survived without severe complications. CONCLUSION AFE is associated with significant maternal morbidity. This study highlights the importance of providing advanced training for the delivery suite staff for cases of maternal cardiovascular collapse secondary to AFE and increasing awareness for this rare and devastating obstetric condition.
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Affiliation(s)
- Shiri Skolnik
- a Department of Anesthesia, and Sackler Faculty of Medicine , Rabin Medical Center, Beilinson Hospital, Petach Tikvah Israel, Tel Aviv University , Tel Aviv , Israel
| | - Alexander Ioscovich
- b Department of Anesthesia , Shaare Zedek Medical Center, Hebrew University of Jerusalem , Jerusalem , Israel
| | - Leonid A Eidelman
- a Department of Anesthesia, and Sackler Faculty of Medicine , Rabin Medical Center, Beilinson Hospital, Petach Tikvah Israel, Tel Aviv University , Tel Aviv , Israel
| | - Atara Davis
- a Department of Anesthesia, and Sackler Faculty of Medicine , Rabin Medical Center, Beilinson Hospital, Petach Tikvah Israel, Tel Aviv University , Tel Aviv , Israel
| | - Anat Shmueli
- c Department of Obstetrics and Gynecology, and Sackler Faculty of Medicine , Rabin Medical Center, Beilinson Hospital, Petach Tikvah Israel, Tel Aviv University , Tel Aviv , Israel
| | - Amir Aviram
- d Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center , Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Sharon Orbach-Zinger
- a Department of Anesthesia, and Sackler Faculty of Medicine , Rabin Medical Center, Beilinson Hospital, Petach Tikvah Israel, Tel Aviv University , Tel Aviv , Israel
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Umazume T, Hayasaka S, Kato F, Ishikawa S, Morikawa M, Minakami H. Sudden maternal hypoxemia during elective cesarean section in a woman with placenta previa. Clin Case Rep 2017; 5:1668-1671. [PMID: 29026569 PMCID: PMC5628217 DOI: 10.1002/ccr3.1142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 06/29/2017] [Accepted: 07/26/2017] [Indexed: 11/06/2022] Open
Abstract
There have been no reports regarding imaging‐documented bronchospasm in patients with amniotic fluid embolism (AFE). In a woman with scheduled cesarean section for placenta previa, transient bronchospasm and pulmonary hypertension were documented explaining a sudden drop in SpO2. Mild AFE was the most likely diagnosis in this patient.
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Affiliation(s)
- Takeshi Umazume
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Satoshi Hayasaka
- Department of Anesthesia; Hokkaido University Hospital; Sapporo Japan
| | - Fumi Kato
- Department of Diagnositic and Interventional Radiology; Hokkaido University Hospital; Sapporo Japan
| | - Satoshi Ishikawa
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Mamoru Morikawa
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Hisanori Minakami
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
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Taylor J, Taylor L. A 32-Year-Old Woman with Postpartum Cardiac Arrest. J Emerg Nurs 2017. [PMID: 28629582 DOI: 10.1016/j.jen.2017.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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