Maternal death following cardiopulmonary collapse after delivery: Amniotic fluid embolism or septic shock due to intrauterine infection?

Roberto Romero*, Nicholas Kadar, Edi Vaisbuch, Sonia S. Hassan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)113-125
Number of pages13
JournalAmerican Journal of Reproductive Immunology
Volume64
Issue number2
DOIs
StatePublished - Aug 2010
Externally publishedYes

Keywords

  • Bacteremia
  • Cardiorespiratory arrest
  • Chorioamnionitis
  • Disseminated intravascular coagulation
  • Fever
  • Intraamniotic infection
  • Pregnancy
  • Preterm labor
  • Tumor necrosis factor-α

Fingerprint

Dive into the research topics of 'Maternal death following cardiopulmonary collapse after delivery: Amniotic fluid embolism or septic shock due to intrauterine infection?'. Together they form a unique fingerprint.

Cite this