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Radiographic appearance of intrathoracic complications of pregnancy.

The authors reviewed all chest radiographs obtained for pregnant women at a university hospital over a 15-year period to determine the intrathoracic complications of pregnancy and diseases occurring during pregnancy. The characteristic physiologic changes seen on chest radiographs during normal pregnancy are reviewed. Examples of intrathoracic diseases that may occur in pregnant patients include pulmonary embolism, amniotic fluid embolism, beriberi, aspiration pneumonia, community-acquired pneumonia, viral pneumonia, asthma, systemic disease, trophoblastic disease and peripartum pulmonary edema. The authors discuss the radiation biology implications of performing chest radiography during pregnancy and conclude that the benefit that the fetus receives from diagnosis and treatment of the mother's disease may be greater than the risk of radiation exposure.

Adolescent↗

Cesarean section and maternal mortality in Sweden 1973-1979.

During the years 1973-79, 704732 births took place in Sweden and 63 075 cesarean sections (CS) were performed. Within the study period there were 20 maternal deaths associated with delivery or puerperium. Thirteen of these patients were delivered by CS and 7 by the vaginal route. The hospital records of the 13 deaths associated with CS were closely analysed and it was found that 5 of the patients were critically ill before the beginning of surgery, and the CS per se was not responsible for these deaths. The 8 remaining maternal deaths gave a corrected (cesarean-attributed) maternal mortality rate of 12.7/100 000 cesarean deliveries. For vaginal deliveries the mortality rate was 1.1/100 000 deliveries. Thus, the risk of maternal death from CS in Sweden was twelve times as high as that from vaginal parturition. All maternal deaths except one, associated with CS, occurred after emergency operation. No deaths were ascribable to anesthesia complications. The most common causes of death after CS were pulmonary embolism, amniotic fluid embolism, coagulopathy and peritonitis. Time trends in the causes of maternal death in Sweden are discussed.

Adult↗

[Effects of amniotic fluid embolism-like plasma on isolated perfused rabbit lungs].

OBJECTIVE: In order to investigate whether amniotic fluid could induce the release of mediators from blood cells which would damage the lungs, an isolated perfused rabbit lung (IPRL) was exposed to amniotic fluid embolism-like plasma (AFEP) and the injury of AFEP to lungs and the protective effects of ibuprofen were studied. METHODS: 10 ml human amniotic fluid and 50 ml heparized rabbit blood were incubated together with or without ibuprofen (600 micrograms) at 37 degrees C for 30 min and centrifuged. Supernatants were taken and were referred to as AFEP or ibuprofen AFEP. IPRL was perfused with AFEP, ibuprofen AFEP, simple amniotic fluid (SAF), supernatant of amniotic fluid (SnAF), rabbit plasma (RP) and control NS. The changes of pulmonary artery pressure (PAP), respiratory pressure (RP) and lung weight were recorded by computer and compared with control NS group. RESULTS: In groups of SAF, SnAF and RP PAPs were slightly elevated (0.13-0.6 kPa, P > 0.05), and lung weights were not changed. AFEP induced the increase of PAP (3.52 +/- 0.64 kPa, P < 0.05) and lung weight (4.0 +/- 1.0 g, P < 0.01) with the development of lung edema. Administration of ibuprofen prevented partially the APEP-induced increase of PAP (1.87 +/- 0.43 kPa, P < 0.05) and lung weight (0.4 +/- 0.3 g, P < 0.01). CONCLUSION: Amniotic fluid may induce the release of mediators from blood cells, and the latter is the important cause resulting in the pathological changes of lungs in amniotic fluid embolism. Ibuprofen may reduce partially the APEP-induced lung injury.

Animals↗

Unusual forms of pulmonary embolism.

The first word of the title, unusual, captures the theme of this article. The entities discussed here: fat embolism, tumor embolism, venous air embolism, and amniotic fluid embolism, as well as other unusual embolic events are uncommon disorders that occur in specific circumscribed clinical settings. We have attempted to provide a cognitive jolt to remind the reader to consider these unusual events in appropriate differential diagnoses. No laboratory test, physical finding, or patient complaint will yield a timely diagnosis. Yet, these entities can be acutely life threatening; swift recognition is imperative. Timely and effective therapy rests on the clinical certainty that a test is not likely to establish. It is, perhaps, the greatest demand placed upon the agile clinical mind--to think of it!

Adrenal Cortex Hormones↗