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Cardiovascular Collapse in the Pregnant Patient, Rescue Transesophageal Echocardiography and Open Heart Surgery

Published:August 16, 2016DOI:https://doi.org/10.1053/j.jvca.2016.04.020
      ANESTHESIOLOGISTS with a practice in obstetrics must be acutely aware of the differential diagnosis of maternal cardiovascular collapse during pregnancy. The overall risk of maternal death is 6.5 in 100,000 deliveries and typically occurs in the third trimester.
      • Clark S.L.
      • Belfort M.A.
      • Dildy G.A.
      • et al.
      Maternal death in the 21st century: Causes, prevention, and relationship to Cesarean delivery.
      Deaths in the first and second trimesters are rare. The most common etiologies include pre-eclampsia (16%), amniotic fluid embolism (AFE) (14%), hemorrhage (12%), cardiac disease (11%), and pulmonary thromboembolism (9%). Less common etiologies include infection, medication error, and ectopic pregnancy. There is great difficulty in distinguishing between these disorders as they may have similar clinical presentations including hypoxia, cardiovascular lability, bleeding, and neurologic manifestations such as mental status changes and seizures.
      • Clark S.L.
      • Belfort M.A.
      • Dildy G.A.
      • et al.
      Maternal death in the 21st century: Causes, prevention, and relationship to Cesarean delivery.
      Transesophageal echocardiography (TEE) may help guide the diagnosis and management of cardiopulmonary collapse in pregnant patients.
      • James C.F.
      • Feinglass N.G.
      • Menke D.M.
      • et al.
      Massive amniotic fluid embolism: Diagnosis aided by emergency transesophageal echocardiography.
      • Lapinsky S.E.
      Cardiopulmonary complications of pregnancy.
      The authors present a case of a 37-year-old female who was admitted for intrauterine fetal demise (IUFD), which was complicated by cardiovascular collapse necessitating cardiac surgery. Consent for this report was obtained from the patient.

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      References

        • Clark S.L.
        • Belfort M.A.
        • Dildy G.A.
        • et al.
        Maternal death in the 21st century: Causes, prevention, and relationship to Cesarean delivery.
        Am J Obstet Gynecol. 2008; 199: 36.e1-36.e5
        • James C.F.
        • Feinglass N.G.
        • Menke D.M.
        • et al.
        Massive amniotic fluid embolism: Diagnosis aided by emergency transesophageal echocardiography.
        Int J Obstet Anesth. 2004; 13: 279-283
        • Lapinsky S.E.
        Cardiopulmonary complications of pregnancy.
        Crit Care Med. 2005; 33: 1616-1622
        • Stahl R.L.
        • Javid J.P.
        • Lackner H.
        Unrecognized pulmonary embolism presenting as disseminated intravascular coagulation.
        Am J Med. 1984; 76: 772-778
        • Roberts C.L.
        • Algert C.S.
        • Knight M.
        • et al.
        Amniotic fluid embolism in an Australian population-based cohort.
        BJOG: Int J O&G. 2010; 117: 1417-1421
        • Pesola G.R.
        • Carlon G.C.
        Pulmonary embolus-induced disseminated intravascular coagulation.
        Crit Care Med. 1987; 15: 983-984
        • Markin N.W.
        • Gmelch B.S.
        • Griffee M.J.
        • et al.
        A review of 364 perioperative rescue echocardiograms: Findings of an anesthesiologist-staffed perioperative echocardiography service.
        J Cardiothorac Vasc Anesth. 2015; 29: 82-88
        • Rath W.H.
        • Hoferr S.
        • Sinicina I.
        Amniotic fluid embolism: An interdisciplinary challenge: Epidemiology, diagnosis and treatment.
        Dtsch Arztebl Int. 2014; 111: 126-132
        • O’Neill J.O.
        • Iqbal R.
        • McGarry K.
        “Thrombus in transit”—The role of echocardiography in the diagnosis of massive pulmonary embolism and a review of the literature.
        Acta Cardiol. 2002; 57: 291-294
        • Shechtman M.
        • Ziser A.
        • Markovits R.
        • et al.
        Amniotic fluid embolism: Early findings of transesophageal echocardiography.
        Anesth Analg. 1999; 89: 1456-1458
        • Stanten R.D.
        • Iverson L.I.G.
        • Daugharty T.M.
        • et al.
        Amniotic fluid embolism causing catastrophic pulmonary vasoconstriction: Diagnosis by transesophageal echocardiogram and treatment by cardiopulmonary bypass.
        Obstet Gynecol. 2003; 102: 496
        • Ecker J.L.
        • MacGillivray T.E.
        • Fitzsimons M.G.
        Case 40-2012: A woman with cardiorespiratory arrest after a cesarean section.
        N Engl J Med. 2013; 368: 1261
        • McConnell M.V.
        • Solomon S.D.
        • Rayan M.E.
        • et al.
        Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism.
        Am J Cardiol. 1996; 78: 469-473
      1. Bourjeily G, Paidas M, Khalil H, et al. Pulmonary embolism in pregnancy. The Lancet Elsevier Ltd, 375:500-512, 2010