Sudden Death because of Massive Pulmonary Thromboembolism and Concomitant Cerebrovascular Trophoblastic Embolism following Artificial Abortion

Abstract

A rare case of sudden death due to cerebral embolization of trophoblastic tissue and concomitant massive pulmonary embolization following artificial abortion in a 42-year-old woman with poorly regulated hypertension and chronic smoking is described. Histopathological analysis showed syncytiotrophoblast cells, positive on hPL immunostaining, obstructing vascular lumina in the small perforating arteries irrigating the diencephalon. There was no trophoblast invasion of capillary walls. Severe perivascular edema and lymphocytic infiltration were observed. No trophoblastic cells were found in the pulmonary circulation.

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

“…Death following TE is rare and has been reported in cases of molar pregnancies [11], as a side effect of chemotherapy of choriocarcinoma [12], and in a normal pregnancy [13]. An association of cerebral trophoblastic cells embolism and massive pulmonary embolization leading a sudden death following artificial abortion has been previously reported in a 42-year-old woman [5]. Ikarashi found TE in three of eight maternal autopsy cases [14].…”

“…Trophoblastic cell embolism is a rare condition, which is mainly associated with preeclampsia or gestational trophoblastic disease. An association of cerebral trophoblastic cell embolism and massive pulmonary embolization leading a sudden death following artificial abortion during the first trimester has been previously reported in a 42-year-old woman [5].…”

Nonhemorrhagic Primary Obstetric Shock

“…The abrupt onset of obstetric shock is caused by intravascular influx of trophoblasts, i.e., amniotic fluid, which trigger the DIC cascade via thromboplastin, by thromboembolism, or by severe septic shock which can be verified by laboratory testing or on the basis of the serious clinical picture with secondary hemorrhage [3,11] . Massive embolic events with an acute clinical picture mostly have a lethal outcome [3,21] or are associated with very low survival rates and permanent damage to vital organs.…”

“…Trophoblast embolism is extremely rare, with only sporadic cases described as having a postmortem diagnosis of severe shock: massive pulmonary embolism following abruptio placentae caused by car crash [27] , intrapartum [3,28] , and after abortion [21] . Clinical picture and treatment are identical to those for AFE, based on the principles of ICU, DIC, and ARDS management.…”