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PubMed1983

Amniotic fluid embolus-like syndrome presenting in the second trimester of pregnancy.

Two cases of sudden cardiopulmonary embarrassment and profound disseminated intravascular coagulation occurring in the second trimester of pregnancy are described and a third from the literature is reviewed. All 3 pregnancies were complicated by persistent uterine bleeding. With supportive care, all mothers survived with rapid and spontaneous resolution of the clotting abnormalities. It is speculated that the pathophysiology of this event involves an amniotic fluid embolus. At this time no specific recommendations for prevention or treatment can be made. Vigorous support of the mother appears to offer the best chance for a successful outcome.

Abortion, Therapeutic↗
PubMed1989

A case of sudden death by decidual cell embolism.

A 35-year-old multipara died suddenly of a pulmonary embolism about 12 h after delivery. The morphological features and the entry site of the emboli into the circulation suggested that they were decidual cells. Intact decidual cells accounted for only a minority of the emboli: the great majority were cells that had lost their nuclei and/or had been fragmented. The presence of embolized areas, accompanied by fibroblasts and newly formed capillaries, suggested that the embolization process had started before the beginning of labor. However, no symptoms suggesting embolism had been recorded on the clinical chart.

Adult↗
PubMed1995

Acute subdural hematoma following disseminated intravascular coagulation associated with an obstetric catastrophe.

The clinical, laboratory, radiological and operative recordings of a patient with disseminated intravascular coagulation (DIC) related to therapeutic abortion is reported. During a comatose state following respiratory arrest, anisocoria with right dilated unreactive pupil and decerebration signs appeared. A brain CT scan showed a right frontotemporal hemorrhage. On surgical intervention a subdural hematoma was found and removed. The patient remained in a persistent vegetative state. The rarity of subdural hematoma complicating DIC is presented and the causes of intracranial bleeding in obstetrics are reviewed.

Abortion, Therapeutic↗
PubMed2004

Maternal mortality in Australia, 1973-1996.

AIMS: Maternal mortality has declined dramatically over the past 30 years in developed countries. This retrospective study aims to provide an epidemiological overview of maternal deaths in Australia between 1973 and 1996. METHODS: Data were abstracted from national maternal mortality data collection and triennial reports for the period 1973-1996 for women who died from pregnancy-related causes while pregnant or within 42 days of a pregnancy being delivered or terminated. Deaths were restricted to those classified as direct or indirect maternal deaths. Maternal mortality age-specific mortality ratios were calculated. The leading causes of death were examined. RESULTS: Of the 584 deaths, 363 were direct and 221 indirect. The leading causes of direct death were pulmonary embolism (18.4%) and hypertensive disorders (16.3%). Cardiovascular disease accounted for 41% of indirect deaths. The maternal mortality ratio declined from 12.7 deaths per 100,000 confinements in 1973-1975 to 6.2 in 1991-1993, and was 10.0 for the entire 24-year period. For women aged 40-44 years the ratio declined from 165.1 to 14.2 between 1973 and 1996. The ratio for Indigenous mothers was three times higher than for non-Indigenous mothers, being 34.8 in the most recent triennium 1994-1996. CONCLUSIONS: Although maternal deaths are rare in Australia, apparent health inequality persists with Indigenous mothers continuing to have a higher risk of maternal death. While mortality in traditionally higher risk women aged > 40 years has declined, women with morbid cardiovascular disease continue to be over-represented in the deaths. The comparatively high rate of deaths from pulmonary embolism needs to be addressed.

Age Factors↗
PubMedDate not supplied

Maternal mortality at University Teaching Hospital, Lusaka.

Eighty maternal deaths occurring at the University Teaching Hospital (UTH) Lusaka, from 1974-1976 have been reviewed. The maternal mortality rate was 1.5 per 1000 births. The commonest causes of death were pre-eclampsia and eclampsia (23), septicaemia (14), haemorrhage (13) and ruptured uterus (11). Avoidable hospital factors were present in 52 percent of cases, while avoidable outside factors were noted in 27 percent. Thirty two per cent had no antenatal care. The mortality rate may be reduced by increased awareness of high risk patients by medical staff in the central hospital. Improvements in community maternal health services and better transport and communications are essential.

Abortion, Spontaneous↗
PubMed2006

Aprotinin in the management of coagulopathy associated with amniotic fluid embolus.

Amniotic fluid embolus, also known as anaphylactoid syndrome of pregnancy is a rare complication of pregnancy. When it occurs, the maternal mortality rate may be as high as 86%, and in survivors, the morbidity rate may be just as high. Hallmark clinical features include maternal cardiovascular collapse with disseminated intravascular coagulation, and fetal distress. Management centers on strategies to improve oxygenation, support circulation, and correct the coagulopathy. We report the case of a patient who developed amniotic fluid embolus and was effectively managed with aprotinin to control the coagulopathy associated with this devastating complication of pregnancy.

Adult↗
PubMed1982

[Acute coagulation disorder following amniotic fluid infusion].

Penetration of amniotic fluid and its components into maternal circulation may cause more or less sizable obstruction of terminal sections of pulmonary circulation. Disseminated intravascular coagulation (DIC) will be the result of thromboplastic activity in amniotic fluid. Excessive fibrinolytic activity is likely to develop as counterregulation and to cause severe impairment of coagulation. The principle which governs the pathogenesis of such acutely acquired impairment of coagulation is discussed together with necessary diagnosis and therapy, with reference being made to two cases of differentiated courses.

Acute Disease↗
PubMedDate not supplied

Cytologic diagnosis of amniotic fluid embolus. Report of a case.

This paper reports a case of a primigravid woman with the presumptive diagnosis of amniotic fluid embolus who had a blood sample aspirated from the right heart. The blood specimen was sent to the cytology laboratory, processed and then examined for squames and lanugo. The laboratory procedure and results are described.

Adult↗