Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery

Abstract

Introduction Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality.

An atypical presentation of cerebral fat embolism

“…Only a few cases of FES following caesarean delivery have been reported [7,8]. Most FES cases have been reported in young polytrauma patients with FES-related symptoms typically occurring 12-72 h after trauma [9,10].…”

Rare, Fatal Pulmonary Fat Embolism after Acupuncture Therapy: A Case Report and Literature Review

“…It is most frequently observed following severe trauma, particularly long bone fractures and contusions in soft tissue rich in adipose tissue. Nontraumatic pulmonary fat embolism associated with minor soft tissue contusion [2,3], surgery, cancer chemotherapy, hematologic disorders and so on has also been reported [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Intrinsic or extrinsic stimuli evokes a biological response, known as stress [19]; stress can be induced by trauma, blood loss, hypoxia, pain, heat and cold, fear, infection, surgery, and anesthesia.…”

“…PubMed was searched with different combinations of the following keywords: "fat embolism", "nontraumatic", "death", "autopsy", and "case report". Table 1 lists 18 case reports [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] (including this case report) of nontraumatic fat embolism caused by stress, summarized by year, PMID, author age, sex, underlying disease, stress factors, early clinical manifestations, diagnosis tool, affected organs and deterioration. None of these cases had severe fatty tissue damage or long bone fractures, and those with surgical trauma had only minor adipose tissue damage.…”