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Primary Postpartum Haemorrhage
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
If facilities are available, intraoperative cell salvage may be used in the management of PPH. In cell salvage, blood shed within the surgical field is retrieved by an anticoagulated suction apparatus, centrifuged and washed to remove fibrin, debris, plasma, platelets and procoagulant, and subsequently returned to the circulation via a leucocyte depletion filter. It reduces the need for allogenic transfusion and is useful especially in women who refuse blood product transfusion. Although there is a theoretical risk of amniotic fluid embolism and maternal infection from contaminants, in practice, these complications are rare. Sensitisation of a Rhesus negative woman to Rhesus positive fetal blood cells can be prevented by the administration of Anti D immunoglobulin.
Embolism, Ischaemia, Infarction and Shock
Published in Jeremy R. Jass, Understanding Pathology, 2020
Amniotic fluid embolism following childbirth is unpreventable and highly dangerous, though fortunately is very rare. In lethal cases the diagnosis is confirmed at autopsy by the finding of squamous cells and debris of fetal origin impacted within branches of the pulmonary artery.
The cardiovascular system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Mary N Sheppard, C. Simon Herrington
Amniotic fluid embolism is rare but may occur during pregnancy and delivery as a result of early placental detachment, forcing amniotic fluid into the uterine veins. Exfoliated fetal squamous cells from the skin block the pulmonary circulation and cause DIC with a high mortality.
Management of pulmonary arterial hypertension during pregnancy
Published in Expert Review of Respiratory Medicine, 2023
Kaushiga Krishnathasan, Andrew Constantine, Isma Rafiq, Ana Barradas Pires, Hannah Douglas, Laura C Price, Konstantinos Dimopoulos
Pregnancy is associated with an increased risk of thromboembolic events, in particular pulmonary embolism (PE). Thrombosis has been identified as a cause of death in pregnant women with PAH [16]. In this setting, PE can cause a sudden and severe increase in RV afterload, which can trigger cardiogenic shock and prove fatal. PE should always be suspected in patients presenting with new or increasing symptoms of shortness of breath, chest pain, or RV failure. In patients in whom there is a high suspicion of PE, a computed tomography pulmonary angiogram can be performed even during pregnancy [26]. The issue of anticoagulation around pregnancy is discussed later in this review. One should also bear in mind other potentially fatal causes of rapid deterioration including amniotic fluid embolism. This can cause sudden cardiorespiratory collapse due to right ventricular failure, particularly in the peripartum period; however, cases have also been documented in the second trimester. Treatment is mainly supportive and the prognosis is poor; hence, early recognition is vital [27,28].
Radiologic mimics of pulmonary embolism
Published in Postgraduate Medicine, 2021
Amniotic fluid embolism, which is passed into the bloodstream through tears in uterine veins during labor, is a dreaded obstetric complication which carries a mortality of up to 50% and can have neurologic sequelae in as many as 85% of patients [79,80]. The composition of amniotic fluid, desquamated skin cells, lanugo and scalp hair, arachidonic acid metabolites, prostaglandins, and zinc coproporphyrin, can induce a prothrombotic, proinflammatory cascade in terminal organs [81]. In the lungs, this leads to dyspnea, cyanosis, shock, and disseminated intravascular coagulopathy which can follow a biphasic pathologic pattern of initial transient right heart failure due to direct vascular obstruction and subsequent left heart failure and shock due to humorally mediated cardiovascular collapse [79,81,82]. Amniotic fluid embolism may occur during labor (in 70% of cases) or postpartum [83] and can be accompanied with neurologic symptoms of convulsions and hyperreflexia [84]. In the latter stage, chest radiography and CT may demonstrate diffuse bilateral opacities reflective of pulmonary edema [63,85].
A new non-invasive procedure for refractory PPH after vaginal delivery and caesarean section
Published in Journal of Obstetrics and Gynaecology, 2021
As shown in Table 1, BCAC was effective in 17 patients with PPH. Curettage was performed in 5 vaginal delivery patients before BCAC in the case of retention of the placenta, membrane and blood clotting. Of the 18 patients who received the BCAC procedure for the treatment of refractory PPH, only one patient failed. The No 8 patient, a 33 year-old woman, gestational age 40+3 weeks, delivered a 3030 g foetus without any complications; However, 1100 ml blood loss was observed at 30 min after the failure of drugs used for uterine atony, massage of the uterus and BCAC with exclusion of the placental reasons with ultrasound examination; The bleeding still can not be stopped. The reason for bleeding was unknown until the blood oxygen saturation reduced to 70%, hypotension of 46/22 mmHg and persistent bleeding occurred following all failure conservative therapies; Then we considered it may be amniotic fluid embolism syndrome. Thus the drugs like dexamethasone (20 mg) and papaverine (30 mg) and other treatments for amniotic fluid embolism were all administered. But the bleeding still cannot be stopped. When blood loss reached 2000 ml, exploratory laparotomy was performed and at last the hysterectomy was performed for saving the patient's life. The total blood loss was 5000 ml, and 19 U RBC suspension, 1600 ml FFP, 2 U apheresis platelets, 7 g fibrinogen, 6 U cold cryoprecipitate and 600 U prothrombin.