Fatal amniotic fluid embolism during legally induced abortion, United States, 1972 to 1978

Guidotti, Richard; Grimes, David A.; Cates, Willard

doi:10.1016/s0002-9378(16)32629-1

Cited by 55 publications

(16 citation statements)

References 8 publications

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“…Among those who survived more than one hour, 75% had DIC. 4 More recently, in an analysis of the national registry for amniotic fluid emboli, Clarke found that 83% of patients had either laboratory or clinical evidence of a consumptive coagulopathy, s…”

Section: Discussionmentioning

confidence: 99%

Amniotic fluid embolism and isolated disseminated intravascular coagulation

Davies

1999

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 99%

Amniotic fluid embolism and isolated disseminated intravascular coagulation

Davies

1999

Can J Anesth/J Can Anesth

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“…AFE following transabdominal amniocentesis is very rare [88]. Estimates emphasise that AFE has accounted for 12% of all maternal deaths related to legally induced abortion since 1972, with a death-to-case rate of 0.2 per 100,000 abortions [89,90]. AFE is seldom associated with (surgical) manipulation during caesarean section [91], curettage [92], cervical suture removal [93] or repair of an incompetent cervix [93], or after car or motor vehicle accidents [94].…”

Section: Incidencementioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

Eur Respir J

162

127

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Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes.The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than ''simple'' mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung.NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE.Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.

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“…Quelques cas similaires ont été rapportés dans la littérature. [2][3][4] Toutefois, le diagnostic a été retenu uniquement devant le contexte et le tableau clinique sans apporter d'éléments de preuves biologiques et/ou anatomopathologiques.…”

Section: Discussionunclassified

Embolie amniotique compliquant une interruption médicale de la grossesse

Kaaniche

Chaari

Zekri

et al. 2016

Can J Anesth/J Can Anesth

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RésuméContexte L'embolie amniotique est toujours une complication grave et survient généralement pendant le travail ou tout de suite après la naissance de l'enfant. É léments cliniques Nous rapportons le cas d'une patiente victime d'une embolie amniotique au décours d'une interruption médicale de la grossesse à 24 semaines d'aménorrhée suite à la découverte d'un foetus porteur de tératome. Le diagnostic d'embolie amniotique était fortement suspecté devant l'installation immédiate après l'accouchement d'une hypotension artérielle profonde, d'une détresse respiratoire hypoxique, d'un état de coma et d'une coagulopathie intravasculaire disséminée. Des examens complémentaires ont été réalisés pour étayer le diagnostic: l'étude cytologique du prélèvement veineux périphérique et du liquide de lavage broncho-alvéolaire maternel, le dosage sanguin de la tryptase et de l'alphafoetoprotéine et la recherche de la protéine de liaison au facteur de croissance insulinomimétique 1. Conclusion L'embolie amniotique est un diagnostique rare et difficile surtout lors de situations inhabituelles mais qui peut être facilité par la recherche sérique de marqueurs amniotiques et de la tryptase. AbstractBackground Amniotic fluid embolism is always a severe complication and generally occurs during labour or immediately after childbirth. Clinical featuresWe report the case of a patient falling victim to amniotic fluid embolism after the medical termination of her pregnancy at 24 weeks of amenorrhea following the discovery of a teratoma-carrying foetus. The amniotic fluid embolism diagnosis was strongly suspected in the face of the sudden onset of severe arterial hypotension, hypoxic respiratory distress, a coma state and disseminated intravascular coagulopathy immediately after the delivery. Additional tests were conducted to support the diagnosis: cytological testing of a peripheral venous sample and maternal broncho-alveolar lavage fluid, dosing of tryptase and alpha-fetoprotein levels as well as screening for insulin-like growth factor binding protein 1. Conclusion Amniotic fluid embolism is a rare and difficult diagnosis, especially in unconventional settings, yet it can be facilitated by screening for amniotic markers and tryptase.

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Fatal amniotic fluid embolism during legally induced abortion, United States, 1972 to 1978

Cited by 55 publications

References 8 publications

Amniotic fluid embolism and isolated disseminated intravascular coagulation

Amniotic fluid embolism and isolated disseminated intravascular coagulation

Nonthrombotic pulmonary embolism

Embolie amniotique compliquant une interruption médicale de la grossesse

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