Neonatal bronchial obstruction caused by aspiration of placental tissue

Abstract

The patient was a 3,140-g male born at 38 weeks gestation to a 40-yearold gravida 2, para 2 mother. A caesarean section was performed because of prior uterine scar and poly-leiomyomatous uterus; the delivery was extremely difficult. The Apgar scores were 3, 8 and 8 at 1, 5 and 10 min, respectively. Positive pressure ventilation was attempted by bag and mask. A thoracoabdominal radiograph demonstrated mediastinal shift to the left, an opaque left hemithorax, an anterior right pneumothorax and a pneumomediastinum (Fig. 1). He was intubated orally and high-frequency oscillatory ventilation commenced. A suction catheter introduced through the endotracheal tube brought back a fragment of purple soft tissue measuring 1·0.6 cm. His respiratory status improved and the left lung re-aerated. Histological examination revealed the inhaled fragment to be of placental origin.Neonatal aspiration is usually related to amniotic fluid or meconium-stained fluid. Foreign body aspiration is very rarely encountered in neonates. Aspiration of a fragment of suction catheter [1] and aspiration of decidua [2] have previously been reported. The diagnosis of tracheobronchial obstruction secondary to placental fragment aspiration may be considered in neonatal respiratory distress after caesarean section and arduous delivery.