Successful treatment of postpartum shock caused by amniotic fluid embolism with cardiopulmonary bypass and pulmonary artery thromboembolectomy
Article Abstract:
Amniotic fluid embolism is the blockage of blood vessels in the mother caused by a clot of amniotic fluid and fetal particulate matter that has leaked into the general circulation. This rare complication of pregnancy and childbirth occurs in one in 30,000 pregnancies, but despite its rarity it is the most common cause of death during pregnancy, labor, and the period immediately after childbirth. The release of fetal particulate matter into the circulation of the mother may cause cardiovascular collapse, blood clot formation in the pulmonary blood vessels, and severe blood coagulation (clotting) disorders. The medical management of this disorder consists of maintaining blood volume, drug therapy to improve circulation, administration of oxygen, and treatment of abnormal blood coagulation. Despite these measures, death occurs in 86 percent of women with amniotic fluid embolism. The surgical removal of fetal products and blood clots from the circulation within the lungs of the mother may be effective in treating this disorder, although the use of this treatment approach has not been previously reported. A case is described of a 29-year-old woman who developed shock after childbirth. One hour after childbirth, the patient had a cardiac arrest and was resuscitated and treated with inotropic agents, which increase the contractility of the heart. A large embolism was detected in her left lung. The patient was bleeding from intravenous puncture sites, the vagina, and the abdominal incision from the cesarean section. She underwent surgery to remove the embolism, which consisted of fetal cells, confirming the diagnosis of amniotic fluid embolism. After extensive surgery (including cardiopulmonary bypass) and drug treatment for coagulation disorders, the patient improved and has resumed a normal life. This case shows that surgical removal of an embolism within the lungs can lead to improvement of circulation and heart function disorders caused by amniotic fluid embolism. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0002-9378
Year: 1990
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Sudden death associated with terbutaline sulfate administration
Article Abstract:
A woman who went into premature labor and was treated with terbutaline sulphate died suddenly. The 34-year-old woman, pregnant with twins, went into labor at 19 to 20 weeks gestation. Bed rest and oral terbutaline failed to slow the progress of labor. Treatment with a programmed infusion pump was begun during hospitalization. The patient was then treated at home with an infusion of three to four milligrams of terbutaline every 24 hours. One week after beginning therapy, she developed chest pain and shortness of breath. She was found dead by her husband. At the hospital the fetuses were delivered dead by emergency cesarean section. On autopsy, her lungs were found to be swollen and mottled looking. The cause of death was believed to be cardiac arrhythmia complicated by anemia, multiple gestation and hemodilution, an increase in the fluid concentration of the blood.
Publication Name: American Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0002-9378
Year: 1993
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Methylmalonic aciduria in pregnancy: a case report
Article Abstract:
A woman with methylmalonic aciduria was able to carry a pregnancy to term and give birth to a healthy infant. Methylmalonic aciduria is a rare, inborn metabolic defect. In some cases vitamin B12 supplements help, but not in this woman's case. Other treatment is to restrict protein intake. Due to her disease, she consumed more than 6000 calories daily and was underweight. She was given carnitine supplements to correct a deficiency and help prevent the production of a toxic metabolic byproduct resulting from her disease. She gave birth to a healthy infant weighing 3500 g, the 25th percentile for gestational age, at term. There do not appear to be any other reports of pregnancy among women with this disease. The outcome here was good, but results cannot be generalized to other patients, especially those with more severe disease.
Publication Name: American Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0002-9378
Year: 1995
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