TY - JOUR
T1 - Maternal death following cardiopulmonary collapse after delivery
T2 - Amniotic fluid embolism or septic shock due to intrauterine infection?
AU - Romero, Roberto
AU - Kadar, Nicholas
AU - Vaisbuch, Edi
AU - Hassan, Sonia S.
PY - 2010/8
Y1 - 2010/8
N2 - Problem The amniotic fluid embolism (AFE) syndrome is a catastrophic complication of pregnancy frequently associated with maternal death. The causes and mechanisms of disease responsible for this syndrome remain elusive. Method of study We report two cases of maternal deaths attributed to AFE: (1) one woman presented with spontaneous labor at term, developed intrapartum fever, and after delivery had sudden cardiovascular collapse and disseminated intravascular coagulation (DIC), leading to death; (2) another woman presented with preterm labor and foul-smelling amniotic fluid, underwent a Cesarean section for fetal distress, and also had postpartum cardiovascular collapse and DIC, leading to death. Results Of major importance is that in both cases, the maternal plasma concentration of tumor necrosis factor-a at the time of admission to the hospital and when patients had no clinical evidence of infection was in the lethal range (a lethal range is considered to be above 0.1ng/mL). Conclusion We propose that subclinical intraamniotic infection may be a cause of postpartum cardiovascular collapse and DIC and resemble AFE. Thus, some patients with the clinical diagnosis of AFE may have infection/systemic inflammation as a mechanism of disease. These observations have implications for the understanding of the mechanisms of disease of patients who develop cardiovascular collapse and DIC, frequently attributed to AFE. It may be possible to identify a subset of patients who have biochemical and immunological evidence of systemic inflammation at the time of admission, and before a catastrophic event occurs.
AB - Problem The amniotic fluid embolism (AFE) syndrome is a catastrophic complication of pregnancy frequently associated with maternal death. The causes and mechanisms of disease responsible for this syndrome remain elusive. Method of study We report two cases of maternal deaths attributed to AFE: (1) one woman presented with spontaneous labor at term, developed intrapartum fever, and after delivery had sudden cardiovascular collapse and disseminated intravascular coagulation (DIC), leading to death; (2) another woman presented with preterm labor and foul-smelling amniotic fluid, underwent a Cesarean section for fetal distress, and also had postpartum cardiovascular collapse and DIC, leading to death. Results Of major importance is that in both cases, the maternal plasma concentration of tumor necrosis factor-a at the time of admission to the hospital and when patients had no clinical evidence of infection was in the lethal range (a lethal range is considered to be above 0.1ng/mL). Conclusion We propose that subclinical intraamniotic infection may be a cause of postpartum cardiovascular collapse and DIC and resemble AFE. Thus, some patients with the clinical diagnosis of AFE may have infection/systemic inflammation as a mechanism of disease. These observations have implications for the understanding of the mechanisms of disease of patients who develop cardiovascular collapse and DIC, frequently attributed to AFE. It may be possible to identify a subset of patients who have biochemical and immunological evidence of systemic inflammation at the time of admission, and before a catastrophic event occurs.
KW - Bacteremia
KW - Cardiorespiratory arrest
KW - Chorioamnionitis
KW - Disseminated intravascular coagulation
KW - Fever
KW - Intraamniotic infection
KW - Pregnancy
KW - Preterm labor
KW - Tumor necrosis factor-α
UR - http://www.scopus.com/inward/record.url?scp=77958082868&partnerID=8YFLogxK
U2 - 10.1111/j.1600-0897.2010.00823.x
DO - 10.1111/j.1600-0897.2010.00823.x
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C2 - 20236259
AN - SCOPUS:77958082868
SN - 1046-7408
VL - 64
SP - 113
EP - 125
JO - American Journal of Reproductive Immunology
JF - American Journal of Reproductive Immunology
IS - 2
ER -