Abstract
IntroductionRespiratory failure may develop during the later stages of pregnancy and is usually associated with tocolysis or other co-existing conditions such as pneumonia, sepsis, pre-eclampsia or amniotic fluid embolism syndrome.Case presentationWe present the case of a 34-year-old healthy woman with a twin pregnancy at 31 weeks and 6 days who experienced acute respiratory failure, a few hours after administration of tocolysis (ritodrine), due to preterm premature rupture of the membranes. Her chest discomfort was significantly ameliorated after the ritodrine infusion was stopped and a Cesarean section was performed 48 hours later under spinal anesthesia; however, 2 hours after surgery she developed severe hypoxemia, hypotension, fever and mild coagulopathy. The patient was intubated and transferred to the intensive care unit where she made a quick and uneventful recovery within 3 days. As there was no evidence for drug- or infection-related thromboembolic or myocardial causes of respiratory failure, we conclude that our patient experienced a rare type of non-fatal amniotic fluid embolism.ConclusionIn spite of the lack of solid scientific support for our diagnosis, we conclude that our patient suffered an uncommon type of amniotic fluid embolism syndrome and we believe that this report highlights the need for extreme vigilance and a high index of suspicion for such a diagnosis in any pregnant individual.
Highlights
Respiratory failure may develop during the later stages of pregnancy and is usually associated with tocolysis or other co-existing conditions such as pneumonia, sepsis, pre-eclampsia or amniotic fluid embolism syndrome.Case presentation: We present the case of a 34-year-old healthy woman with a twin pregnancy at 31 weeks and 6 days who experienced acute respiratory failure, a few hours after administration of tocolysis, due to preterm premature rupture of the membranes
We present a case of a previously healthy woman with a twin pregnancy who at 31 weeks and 6 days experienced a biphasic pattern of respiratory distress and pulmonary edema, fever and coagulopathy, premature rupture of the membranes (PROM) and use of tocolysis initially after preterm labor and, subsequently, shortly after delivery
Pulmonary edema may develop in pregnancy, especially in the later stages, either as a tocolysis-related complication or due to increased permeability of the pulmonary vasculature, due to pre-eclampsia, septic shock or amniotic fluid embolism (AFE) syndrome
Summary
Pulmonary edema may develop in pregnancy, especially in the later stages, either as a tocolysis-related complication or due to increased permeability of the pulmonary vasculature, due to pre-eclampsia, septic shock or AFE syndrome. Our patient developed a biphasic pattern of acute respiratory distress, with initial chest discomfort and tachypnea that were attributed to, after excluding other possible causes, ritodrine administration due to preterm PROM, and subsequently with severe hypoxemia, hypotension and mild coagulopathy following Cesarean section that were associated with a rare type of non-fatal AFE. Differential diagnosis of severe respiratory distress in such patients may be extremely difficult since common symptoms and signs of sepsis, pneumonia, thromboembolism and acute heart failure sometimes lack sensitivity and specificity, whereas regional anesthetic techniques that are usually implemented for urgent Cesarean section may further complicate the clinical picture. We believe that despite the lack of specific scientific evidence to support our diagnosis, this case represents an uncommon type of non-fatal AFE and physicians responsible for the care of a high-risk pregnancy should be familiar with its clinical course. AFE: amniotic fluid embolism; CRP: C-reactive protein; CT: computed tomography; ICU: intensive care unit; PROM: premature rupture of the membranes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
