Squamous cells in the maternal pulmonary circulation

Sl, Clark; Pavlova, Zdena; Greenspoon, Jeffrey S.; Horenstein, Janet; Jp, Phelan

doi:10.1016/0002-9378(86)90402-3

Cited by 161 publications

(92 citation statements)

References 8 publications

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“…Studies have now shown that squamous cells can appear in the pulmonary blood of heterogenous populations of both pregnant and non-pregnant patients who have undergone pulmonary artery (PA) catheterization. [44][45][46][47][48] The presence of these cells is thought to have resulted from contamination by either exogenous sources during specimen preparation or by epithelial cells derived from the entry site of the PA catheter. 44,45 Since it is difficult to differentiate adult from fetal epithelial cells, the isolated finding of squamous cells in the pulmonary circulation of pregnant patients without amniotic fluid embolus is most likely a contaminant and not indicative of maternal exposure to amniotic fluid.…”

Section: Normal Anatomy and Physiologymentioning

confidence: 99%

“…[44][45][46][47][48] The presence of these cells is thought to have resulted from contamination by either exogenous sources during specimen preparation or by epithelial cells derived from the entry site of the PA catheter. 44,45 Since it is difficult to differentiate adult from fetal epithelial cells, the isolated finding of squamous cells in the pulmonary circulation of pregnant patients without amniotic fluid embolus is most likely a contaminant and not indicative of maternal exposure to amniotic fluid. Further examination of blood specimens taken from pregnant patients, with and without a clinical diagnosis of amniotic fluid embolus reveals that, although squamous cells may be present in both groups, only the former had evidence of other fetal debris such as mucin, vernix and lanugo.…”

Section: Normal Anatomy and Physiologymentioning

confidence: 99%

See 1 more Smart Citation

Amniotic fluid embolus: a review of the literature

Davies

2001

Can J Anesth/J Can Anesth

111

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88Purpose: To review the literature since 1979 to determine the natural history, etiology, diagnosis and potential treatment of amniotic fluid embolus (AFE).Source: English language articles and books published between June 1976 and June 1998 were identified by a computerized medline search using the title or text word amniotic fluid embolus. This same search strategy was repeated and updated to October 1999 by an independent individual using both Medline and Embase. The search was also expanded to include Science Citation Index listing Morgan's 1979 review article. All relevant publications were retrieved and their bibliographies were scanned for additional sources.Principal findings: Randomized controlled trials are not possible with amniotic fluid emboli. The majority of the literature consists of clinical reports combined with occasional limited reviews. Knowledge obtained from these reports suggests that amniotic fluid emboli present as a spectrum of disease that ranges from a subclinical entity to one that is rapidly fatal. Because cases are sporadic and the diagnosis is often unconfirmed, little progress has been made towards understanding its etiology or defining the risk factors. Present management is empirical and directed towards the maintenance of oxygenation, circulatory support and the correction of coagulopathy.Conclusion: Amniotic fluid embolus continues to be a life-threatening but potentially reversible complication unique to pregnancy. It cannot be predicted nor prevented. Review of the literature reveals that there are no standardized investigational methods or protocols to confirm the diagnosis in suspected cases.Objectif : Passer en revue la littérature depuis 1979 pour déterminer l'histoire naturelle, l'étiologie, le diagnostic et le traitement potentiel d'une embolie amniotique (EA).Source : Des articles et des livres de langue anglaise, publiés entre juin 1976 et juin 1998, ont été sélectionnés lors d'une recherche informatisée de données médicales en utilisant les titres ou l'expression amniotic fluid embolus. La même méthode de recherche a été utilisée par un individu indépendant pour obtenir une mise à jour jusqu'en octobre 1999 avec Medline et Embase. La recherche a été étendue au Science Citation Index qui présentait la revue de Morgan de 1979. Tous les articles pertinents ont été retenus et leurs bibliographies examinées pour découvrir des sources supplémentaires.Constatations principales : Les essais contrôlés et randomisés sur l'embolie amniotique sont impossibles. La plus grande partie de la documentation constituée de résumés cliniques combinés à des revues limitées occasionnelles. Les connaissances dégagées de ces résumés suggèrent que l'embolie amniotique se présente comme de multiples affections allant de l'entité subclinique à la maladie rapidement fatale. Les cas étant rares et le diagnostic souvent non confirmé, peu de progrès ont été réalisés pour mieux en comprendre les causes ou pour définir ses facteurs de risque. Le traitement actuel est empirique et vise à maintenir...

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Section: Normal Anatomy and Physiologymentioning

confidence: 99%

Section: Normal Anatomy and Physiologymentioning

confidence: 99%

Amniotic fluid embolus: a review of the literature

Davies

2001

Can J Anesth/J Can Anesth

111

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“…Diagnosis is based on clinical present atio n. Foetal squames in wedge pulmonary capillary aspirate have been used for diagnosis but this is an invasive method. 23 Treatment is mainly supportive. Oxygen supplementation, ventilatory support and maintaining adequate circulatory support.…”

Section: Amniotic Fluid Embolismmentioning

confidence: 99%

Respiratory diseases in pregnancy

Raghu¹,

Pulivarthi²

2015

J Clin Sci Res

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Pulmonary diseases are one of the major indirect causes of maternal deaths. Pregnancy is a unique physiologi-cal state during which changes occur in all systems of the body to meet metabolic needs of both the mother and growing foetus. Enlarging uterus and increasing hormonal levels cause changes in volumes and mechanics of lungs. Understanding the basic physiology of the cardiovascular and respiratory changes during pregnancy along with the pathology of disease processes are vital in making therapeutic decisions. Pre-existing conditions like asthma, tuberculosis, and acute illnesses like pneumonia, acute respiratory distress syndrome (ARDS), pneumothorax can have calamitous effect on mother and child health. Continual foetal monitoring throughout pregnancy is very important in early recognition of foetal jeopardy.

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“…The postmortem diagnosis of AFE is often made at autopsy when fetal squames can be identified in the pulmonary vascular bed. 1,2,9 The presence of fetal squamous cells in the pulmonary circulation was once thought to be pathognomonic for AFE. 1,2,9 However, their presence alone does not confirm the diagnosis as fetal squames have been recovered from the pulmonary circulation in pregnant women who had undergone pulmonary artery catheterization for other reasons and showed no clinical evidence of AFE.…”

Section: Conclusion : On Sait Maintenant Que Les Caractéristiques Phmentioning

confidence: 99%

“…1,2,9 However, their presence alone does not confirm the diagnosis as fetal squames have been recovered from the pulmonary circulation in pregnant women who had undergone pulmonary artery catheterization for other reasons and showed no clinical evidence of AFE. 9 In acute AFE, the initial presenting signs are often seen on the electrocardiogram and the pulse-oximeter. 10 The electrocardiogram may show tachycardia with a right strain pattern and ST-T wave changes, and the pulse-oximeter may reveal a profound and sudden drop in O 2 saturation.…”

Section: Conclusion : On Sait Maintenant Que Les Caractéristiques Phmentioning

confidence: 99%

Embolie amniotique lors d’une interruption de grossesse au deuxième trimestre : exposé d’un cas

Ray

Vallejo

Creinin

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Describe the diagnosis, clinical features, pathophysiology, treatment and anesthetic management of amniotic fluid embolism (AFE) in a patient undergoing second trimester pregnancy termination.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 30-yr-old gravida 2, para 1, woman was admitted for a dilatation and evacuation procedure for underlying intra-uterine fetal demise in her second trimester of pregnancy. Hypotension, shock, respiratory arrest, pulseless electrical activity, hemorrhage, disseminated intravascular coagulopathy, requiring cardiopulmonary resuscitation and blood transfusion complicated her intraoperative care. AFE was considered the most likely cause of this intraoperative event.C Co on nc cl lu us si io on ns s: : It is now recognized that the pathophysiological features of AFE are similar to a type-1 hypersensitivity reaction ranging from mild systemic reaction to anaphylaxis and shock. AFE has a high maternal and fetal morbidity and mortality rate, requiring prompt recognition and treatment. In patients with cardiovascular instability, the treatment of AFE is similar to anaphylaxis requiring aggressive fluid hydration, cardiopulmonary resuscitation, administration of blood products and the use of vasopressors. MNIOTIC fluid embolism (AFE) is a rare life-threatening complication unique to pregnancy. AFE has a mortality rate of 61 to 86% and accounts for approximately 10% of all maternal deaths in the United States. 1,2 AFE has a variable presentation, ranging from mild degrees of organ dysfunction to cardiovascular collapse, coagulopathy and death. 1,2 AFE usually presents at term during labour. 3 In this report, we present a patient in her second trimester of pregnancy who developed sudden hypoxic respiratory failure followed by cardiopulmonary arrest and coagulopathy following dilatation and evacuation (D & E) for intra-uterine fetal demise. Objectif

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Squamous cells in the maternal pulmonary circulation

Cited by 161 publications

References 8 publications

Amniotic fluid embolus: a review of the literature

Amniotic fluid embolus: a review of the literature

Respiratory diseases in pregnancy

Embolie amniotique lors d’une interruption de grossesse au deuxième trimestre : exposé d’un cas

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