[Contribution to the diagnosis of the sudden death due to amniotic embolism].
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The importance is demonstrated of anastomoses between the pulmonary artery and the bronchial artery as well as of the arteriovenous anastomoses that arise from these in microembolism. In cases of air embolism, microembolism in the lungs is seldom. Therefore, there must be particular circumstances that make it possible for little air bubbles to pass the anastomoses from the pulmonary artery via the bronchial artery and the arteriovenous anastomoses into the bronchial vein. The pressure in the bronchial artery must decrease. Under these conditions, blood is shunted from the pulmonary artery to the bronchial artery and little air bubbles can pass via the above-mentioned anastomoses into the pulmonary vein.
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BACKGROUND: Trophoblastic pulmonary embolization usually occurs after evacuation of a molar pregnancy when the uterus is larger than dates and the human chorionic gonadotropin level is > 100,000 mIU/mL. It has a dramatic onset, with dyspnea, tachypnea, bilateral pulmonary infiltrates and low Po2 levels. Treatment requires supportive measures only. Intubation is rarely required. The clinical course is short-lived, with gradual improvement after 48 hours and complete resolution in 72 hours. There are no long-term sequelae. Differential diagnosis includes pulmonary embolization, fluid overload and aspiration. CASE: A 27-year-old, Caucasian woman, gravida 4, para 2, spontaneous abortion 1, developed presumed trophoblastic pulmonary embolization following abdominal hysterectomy for an invasive mole. The clinical course was typical of this condition, with spontaneous clearing in 72 hours with supportive measures only. CONCLUSION: Trophoblastic pulmonary embolization can occur following abdominal hysterectomy for invasive mole as well as after molar evacuation and should be considered part of the differential diagnosis if patients present postoperatively with acute respiratory distress.
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It is well known that the entry of amniotic fluid into the mother's circulation may result in the occurrence of amniotic embolism, and aspiration of meconium by the neonate may cause meconium aspiration syndrome. To study meconium-like substances detected in the urine of mother and neonate during the perinatal period, the authors carefully assayed the Urinary Meconial Index (UMI) in subjects including 100 pregnant women, 171 parturient women, 171 neonates and 68 samples of amniotic fluid. Through the UMI assay, the frequency of the appearance of high UMI, the mode of delivery at high UMI and its effect upon both mother and neonate were studied and the following findings obtained. The entry of meconium into the mother's circulation occurs during labor pains and may be excreted into the mother's urine (6.4%). Labor pains enhance the entry of meconium into the mother's circulation and the entry takes place even in the absence of any clinical signs of rupture of the membranes (p less than 0.01). The entry of meconium into both mother and neonate occurs at a higher rate in dystocia and in cases with meconium-stained amniotic fluid (p less than 0.05). Even in the absence of marked symptoms such as those in meconium aspiration syndrome, the aspiration of meconium affects postnatal course of the newborn (positive CRP, early appearance of bilirubinemia: p less than 0.05).
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