Acute trophoblastic pulmonary embolism during conservative treatment of placenta accreta: case report and review of literature

Wang, Qiu-ming; Liu, Huili; Dang, Q.

doi:10.1186/s40001-015-0185-6

Cited by 8 publications

(3 citation statements)

References 14 publications

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“…Postoperative complications reported with the established conservative approach include severe postpartum hemorrhage, postoperative disseminated intravascular coagulopathy, and infection resistant to antimicrobial therapy that may require laparotomy and hysterectomy [19]. Thus far, the results of using preoperative prophylactic internal iliac artery catheterization as an adjuvant treatment to hysterectomy or in cases of conservative management are equivocal, and they are largely limited by the small sample size of the studies.…”

Section: Discussionmentioning

confidence: 94%

Failed conservative management in a case of placenta percreta lead to total hysterectomy for haemostasis and bladder injury

Rugina¹,

Rugină²,

Ciongradi³

et al. 2017

Arch Clin Cases

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We describe an unfavourable outcome for the conservative management applied to a case of placenta percreta in a 32 year-old woman who referred to our obstetrics department with irregular vaginal bleeding. Her medical history pointed out she had undergone a corporeal caesarean one month before. Ultrasonography revealed a hyperechoic mass in the uterine cavity. After careful investigation by serial values of beta HCG, ultrasound, magnetic resonance imaging (MRI) and exploratory cystoscopy for assessing the degree of placental accretisation we decided to perform an inter-adnexal total hysterectomy with bilateral hypogastric artery ligation. To prevent immediate complications an early diagnosis and a prompt evaluation of the bleeding are important, while a careful follow up is also necessary for predicting any subsequent serious consequences.

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Section: Discussionmentioning

confidence: 94%

Failed conservative management in a case of placenta percreta lead to total hysterectomy for haemostasis and bladder injury

Rugina¹,

Rugină²,

Ciongradi³

et al. 2017

Arch Clin Cases

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“…He described knots of multinucleated syncytiotrophoblast in the myometrial vessels and in the lung microcirculation. TE was then described in gestational trophoblastic diseases, after elective abortion [7] and conservative treatment of placenta accreta [8]. Garner et al [9] reported on trophoblastic pulmonary embolization in a 27-year-old woman following abdominal hysterectomy for invasive gestational trophoblastic disease (Mola destruens), with complete recovery after 72 h without long-term sequelae.…”

Section: Discussionmentioning

confidence: 99%

Fatal massive pulmonary thromboembolism and concomitant pulmonary trophoblastic embolism associated with exaggerated placental site reaction: a case study

Pina¹,

Kimmoun

Marchand³

et al. 2021

Int J Legal Med

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Pulmonary embolism is a major cause of maternal morbidity during pregnancy. Beside the frequently encountered thromboembolism, trophoblastic cell embolism has also been reported in a few case reports. This phenomenon may be symptomless in physiological gestational process but is more pronounced in contexts of preeclampsia or gestational trophoblastic disease. It was exceptionally reported to be associated with death. Here, we report the case of a 15-year-old girl, who experienced dyspnea followed by cardiac arrests and disseminated intravascular coagulation. Echocardiography showed a massive proximal pulmonary embolism. Abdominal sonography revealed that she was 11 weeks pregnant. Autopsy confirmed the presence of multiple clot emboli in the proximal pulmonary arteries. Additionally, the histopathological examination showed a massive syncytiotrophoblastic embolism in the lung microcirculation. Microscopic examination of the uterus revealed an exaggerated placental site reaction. In conclusion, this exhaustive post-mortem study describes a previously unreported association between exaggerated placental site reaction and pulmonary trophoblastic embolism, with fatal issue. Forensic pathologists should be aware that a large sampling of the lungs and uterus and examination of both placenta and fetus are needed to achieve this diagnosis. This case study emphasizes the need for further work elucidating pathways of trophoblast deportation.

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“…The first one to be mentioned was reported in late 1960s where a syncytial trophoblastic PE was presented in a patient with placenta increta and preeclampsia [12]. Like other types of emboli, a trophoblastic embolism can lead to catastrophic consequences causing sudden death [12][13][14]. Therefore, awareness of this Fig.…”

Section: Discussionmentioning

confidence: 99%

“You only live twice”: multidisciplinary management of catastrophic case in placenta Accreta Spectrum-a case report

Atallah

Zeid

Moubarak

et al. 2020

BMC Pregnancy Childbirth

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Background: Placenta percreta is associated with high hemorrhagic risk and can be complicated with fatal thromboembolic events. Involving a multidisciplinary team in the treatment of these patients is mandatory to reduce morbidity and mortality. Case presentation: This paper reports the case of a 22-year-old patient with placenta percreta who was referred to our tertiary care center for delivery. Few hours after undergoing a successful cesarean hysterectomy, the patient developed a pulmonary embolism and cardiac arrest. A transthoracic echocardiogram done in the intensive care unit (ICU) showed a thrombus in the right ventricle. After cardiac resuscitation, the patient underwent an urgent thoracotomy and a pulmonary artery thrombectomy; many clots were retrieved from the pulmonary artery. After weaning from extracorporeal circulation, an intraoperative transesophageal cardiac ultrasound enabled the medical team to detect a new free-floating thrombus in the right atrium and right ventricle, and consequently to perform an embolectomy and prevent the patient's death. Conclusion: This case emphasizes the role of multidisciplinary team in treating high-risk obstetric cases that could be complicated with massive and fatal thromboembolic events. The use of intraoperative transthoracic echocardiography helps in detecting a new thrombus and guides the anesthesiologist in the intra-operative monitoring.

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Acute trophoblastic pulmonary embolism during conservative treatment of placenta accreta: case report and review of literature

Cited by 8 publications

References 14 publications

Failed conservative management in a case of placenta percreta lead to total hysterectomy for haemostasis and bladder injury

Failed conservative management in a case of placenta percreta lead to total hysterectomy for haemostasis and bladder injury

Fatal massive pulmonary thromboembolism and concomitant pulmonary trophoblastic embolism associated with exaggerated placental site reaction: a case study

“You only live twice”: multidisciplinary management of catastrophic case in placenta Accreta Spectrum-a case report

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