Feto-pathological examination showed major foci of neuronal necrosis scattered within the basal ganglia and around the third ventricle, and ischemic damage in all cerebellar nuclei examined. The placenta did not show amniotic embolus in the vessels of the chorionic plate.AFE is usually present in cases that combine maternal cardiovascular shock, neurological disorders, and hemorrhage with disseminated intravascular coagulopathy [1,2]. In the present case, the sudden onset of symptoms in the absence of other known causes immediately suggested AFE. Diagnosis can be made even if epithelial cells found in maternal blood cannot be proved to be fetal cells [1]. The increase in serum tryptase indicates mast cell degranulation, which is observed inconsistently in AFE [4]. Because the pregnancy proceeded without other notable events it seems likely that the ischemic fetal brain damage was caused by severe hypoxia during AFE.AFE can occur in the absence of labor during the second trimester of pregnancy and should be considered in the presence of sudden respiratory, neurological, or cardio-vascular distress. Fetal consequences can occur despite full maternal recovery.

Background During the SARS-CoV-2 (COVID-19) pandemic, routine antenatal care was disrupted, and pregnant women positive for COVID-19 were at increased risk of caesarean section, intensive care admission or neonatal unit admission for their baby. Virtual care and telehealth can reduce barriers to care and improve maternity outcomes, and adoption has been encouraged by health authorities in the United Kingdom. Methods Norfolk and Norwich University Hospitals Trust deployed a flexible maternity virtual ward (MVW) service using the Current Health platform to care for pregnant women during the pandemic. Patients were monitored either intermittently with finger pulse oximetry or continuously with a wearable device. We outline the MVW technology, intervention and staffing model, triage criteria and patient feedback, as an example of an operational model for other institutions. Results Between October 2021 and February 2022, 429 patients were referred, of which 228 were admitted to the MVW. Total bed-days was 1,182, mean length of stay was 6 days (SD 2.3, range 1–14 days). Fifteen (6.6%) required hospital admission and one (0.4%) critical care. There were no deaths. Feedback alluded to feelings of increased safety, comfort, and ease with the technology. Conclusions The MVW offered a safety net to pregnant women positive for COVID-19. It provided reassurance for staff, while relieving pressures on infrastructure. When setting up similar services in future, attention should be given to identifying clinical champions, triage criteria, technology and alarm selection, and establishing flexible escalation pathways that can adapt to changing patterns of disease.

A 42-year-old primigravida was admitted to the delivery suite for induction of labour at term due to gestational diabetes and pre-eclampsia. Her booking body mass index was 46 and she had known, well-controlled asthma. Active labour was established. When she was 8–9 cm dilated, she required fetal blood sampling. At the end of the procedure, the patient had a sudden cardiac arrest. High-flow oxygen at the rate of 15 litres was started with bag and mask and immediate maternal cardiopulmonary resuscitation (CPR) was commenced. After 3 minutes of CPR, a decision was made to perform a perimortem caesarean section to aid effective resuscitation. The baby was delivered swiftly. The patient began to respond and showed signs of life. The patient was transferred to theatre for suturing. The massive postpartum haemorrhage protocol was initiated. The patient was transfused with three units of packed red blood cells, three units of fresh frozen plasma, and two units of platelets. The total blood loss was about 3.5 litres. She recovered in an intensive therapy unit. After 72 hours, her clinical assessment excluded any neurological or other ongoing morbidity. Amniotic fluid embolism was suspected as the cause for cardiac arrest. As the patient made a very quick postoperative recovery, a bronchial lavage was thought to be clinically unnecessary. The baby, initially admitted to the baby unit, was also discharged on Day 3 of life with no morbidity. Both mother and baby were completely well at a 3-month postnatal follow-up visit.

The results from this study add to the growing body of evidence that shows there is no increased risk of Caesarean section or other serious complications if women are induced for reasons thought to be not medically justified by medical professionals.

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