medigraphic.com

2006, Number S1

<< Back Next >>

Rev Mex Anest 2006; 29 (S1)

Embolic complications in the parturient

Dolak JA

Language: English
References: 40
Page: 55-57
PDF size: 70.81 Kb.


Text Extraction

Embolic events are the current predominant cause of maternal death (~20%) in the United States(1). They are also the most common cause of acute hemodynamic and respiratory collapse during pregnancy(2). Embolized materials during pregnancy include: thrombus, air, amniotic fluid, and trophoblastic tissue. While the risk factors, presentation, course, and prognosis are all somewhat different with these embolic events, they tend to follow a similar initial course with obstruction of the pulmonary vasculature and/or pulmonary outflow tract leading to V/Q mismatch and compromise of cardiac output through mechanical obstruction, release of vasoactive mediators - all of which ultimately result in clinically-significant hypoxemia. Additionally, a disseminated intravascular coagulation (DIC) picture may develop with either air or amniotic (especially prominent) embolism. In contrast to other embolic events, trophoblastic embolization uniquely carries the risk of malignant spread in any seeded tissue bed.


REFERENCES

  1. Kaunitz AM, Hughes JM, Grimes DA, Smith JC, Rochat RW, Kafrissen ME. Causes of maternal mortality in the United States. Obstet Gynecol 1985;65:605-12.

  2. Gei AF, Vadhera RB, Hankins GD. Embolism during pregnancy: thrombus, air, and amniotic fluid. Anesthesiol Clin North America 2003;21:165-82.

  3. Orr JW Jr, Austin JM, Hatch KD, Shingleton HM, Younger JB, Boots LR. Acute pulmonary edema associated with molar pregnancies: a high-risk factor for development of persistent trophoblastic disease. Am J Obstet Gynecol 1980;136:412-5.

  4. Ie S, Rubio ER, Alper B, Szerlip HM. Respiratory complications of pregnancy. Obstet Gynecol Surv 2002;57:39-46.

  5. Stirling Y, Woolf L, North WR, Seghatchian MJ, Meade TW. Haemostasis in normal pregnancy. Thromb Haemost 1984;52:176-82.

  6. Weiner CP, Kwaan H, Hauck WW, Duboe FJ, Paul M, Wallemark CB. Fibrin generation in normal pregnancy. Obstet Gynecol 1984;64:46-8.

  7. ACOG. Thromboembolism in pregnancy. ACOG Bulletin No. 234, 1987.

  8. Witlin AG, Mattar FM, Saade GR, Van Hook JW, Sibai BM. Presentation of venous thromboembolism during pregnancy. Am J Obstet Gynecol 1999;181:1118-21.

  9. Spritzer CE, Evans AC, Kay HH. Magnetic resonance imaging of deep venous thrombosis in pregnant women with lower extremity edema. Obstet Gynecol 1995;85:603-7.

  10. Fong J, Gadalla F, Druzin M: Venous emboli occurring cesarean section: the effect of patient position. Can J Anaesth 1991;38:191-5.

  11. Leu TW, Tay DH, Thomas E. Venous air embolism during cesarean section: More common than previously thought. Anesth Analg 1993;77:448.

  12. Lowenwirt IP, Chi DS, Handwerker SM. Nonfatal venous air embolism during cesarean section: a case report and review of the literature. Obstet Gynecol Surv 1994;49:72.

  13. Kawahito S, Kitihata H, Kimura H, et al. Hypoxemia during cesarean section - evaluation of venous air embolism by transesophageal echocardiography. Masui 1995;44:10.

  14. Fong J, Gradalla F, Pierri MK, et al. Are Doppler-detected venous emboli during cesarean section air embol. Anesth Analg 1990;71:254.

  15. Flanagan J, Slimack J, Black D, et al. The incidence of venous air embolism in the parturient. Reg Anesth 1990;15:A10.

  16. Kaiser RT. Air embolism death of a pregnant woman secondary to orogenital sex. Acad Emerg Med 1994;1:555-8.

  17. Handler JS, Bromage PR. Venous Air embolism during cesarean delivery. Reg Anesth 1990;15:170.

  18. Bromage PR, Hohman WA. Uterine posture and incidence of venous air embolism (VAE) during cesarean section. Reg Anesth 1991;15:529.

  19. Skerman JH, Huckaby T, Oherson WN. Embolin pregnancy. In: Datta S. (ed) Anesthetic and obstetrical management of high risk pregnancy St. Louis, Mosby–Yearbook 1991.

  20. Naulty JS, Ostheimer GW, Datta S, et al. Incidence of venous sir embolism during epidural catheter insertion. Anesthesiology 1982;57:410.

  21. Presson RG Jr., Kirk KR, Haselby KA, et al. Effect of ventilation with soluble and diffusible gases on the size of air embol. J Appl Physiol 1991;70:1068.

  22. Collins KA, Davis GJ, Lantz PE. An unusual case of maternal & fetal death due to vaginal insufflation of cocaine am S. Forensic Med Pathol 1994;15:335.

  23. Sharma SK, Joshi GP. Pulmonary embolism In Gambling Dr, Douglas MJ. (ed) Obstetric anesthesia and uncommon disorders. Philadelphia, W.B. Saunders Company, 1998.

  24. Alvaran SB, Toung JK, Graff TE, Benson DW. Venous air embolism; Comparative merits of external cardiac massage intracardiac aspiration, and left lateral decubitus position. Anesth Analg 1978;57:1660.

  25. Tibbles PM, Edelsberg JS. Hyperbaric-oxygen therapy. N Engl J Med 1996;334:1642-8.

  26. Clark SL, Hankins GD, Dudley DA, Duldy GA, Porter TF. Amniotic fluid embolism: analysis of the national registry. Am J Obstet Gynecol 1995;172:1158-67.

  27. Malinow AM. Embolic disorders. In: Chestnut DA (ed). Obstetric Anesthesia. Principles and Practice, 2nd Edition St. Louis, Mosby. Inc., 1999.

  28. Clark SL. Amniotic fluid embolism. Crit Care Clin 1991;7:877-82.

  29. Lockwood CJ, Bach R, Guha A, Zhou XD, Miller WA, Nemerson Y. Amniotic fluid contains tissue factor, a potent initiator of coagulation. Am J Obstet Gynecol 1991;165:1335-41.

  30. Petroianu GA, Altmannsberger SH, Maleck WH, Assmus HP, Friedberg C, Bergler WF, Rufer R. Meconium and amniotic fluid embolism: effects on coagulation in pregnant mini-pigs. Crit Care Med 1999;27:348-55.

  31. Hankins GD, Snyder RR, Clark SL, Schwartz L, Patterson WR, Butzin CA. Acute hemodynamic and respiratory effects of amniotic fluid embolism in the pregnant goat model. Am J Obstet Gynecol 1993;168:1113-29.

  32. Courtney LD. Amniotic fluid embolism. Obstet Gynecol Surv 1974;29:169-77.

  33. Kanayama N, Yamazaki T, Naruse H, Sumimoto K, Horiuchi K, Terao T. Determining zinc coproporphyrin in maternal plasma—a new method for diagnosing amniotic fluid embolism. Clin Chem 1992;38:526-9.

  34. Kobayashi H, Ohi H, Terao T. A simple, noninvasive, sensitive method for diagnosis of amniotic fluid embolism by monoclonal antibody TKH-2 that recognizes NeuAc alpha 2-6 GalNAc. Am J Obstet Gynecol 1993;168:848-53.

  35. Dolak JA, Dubsky JA, Waters JH. A novel in vitro model of amniotic fluid-induced hypercoagulability. Anesthesiology 2004;Suppl 1:A105.

  36. Dolak JA, Dubsky JA, Waters JH. Increases in clot initiation and rate of fibrin formation are responsible for amniotic fluid-induced hypercoagulability. Anesthesiology 2004;Suppl 1:A104.

  37. Chantigian RC, Chantigian PDM. Problems of early pregnancy. In: Chestnut DH. (ed) Obstretric anesthesia: principles and practice. 2nd Edition, St. Louis, Mosby, Inc., 1999.

  38. Garner EI, Chang-Lee WY, Lu KH, Goldstein DP, Berkowitz RS. Trophoblastic pulmonary embolization after hysterectomy for invasive complete mole. A case report. J Reprod Med 1999;44:908-12.

  39. Cotton DB, Bernstein SG, Read JA, Benedetti TJ, D’Ablaing G, Miller FC, Morrow CP. Hemodynamic observations in evacuation of molar pregnancy. Am J Obstet Gynecol 1980;138:6-10.

  40. Kohorn EI. Clinical management and the neoplastic sequelae of trophoblastic embolization associated with hydatidiform mole. Obstet Gynecol Surv 1987;42:484-8.




2020     |     www.medigraphic.com