Syncytio-trophoblast pulmonary embolism: cause of death or incidental finding. Case report and literature review.

Abstract

A 37 years old female performed in vitro fertilisation and artificial insemination resulting in a multifetal pregnancy (4 embryos). A fetal reduction was performed at 16 weeks gestational age, by transcervical puncture and potassium chloride injection in the fetal heart of one of four the fetuses. After several hours the state of health of the patient started to decline rapidly with dyspnea, tachypnea and progressive arterial hypotension. The patient died 40 hours after the fetal reduction procedure due to DIC and MOFS. A post- mortem blood culture was evidenced a Citrobacter freundii bacteriemia. The autopsy revealed a suppurative acute endometritis, multiple foci of leukocyte sticking in visceral vessels, scattered hyaline membranes, marked vascular congestion and alveolar edema in the lungs, micro thrombi of fibrin in sinusoidal capillaries of the liver and renal glomeruli,. focal renal tubular necrosis and extensive degenerative changes in kidneys. Syncytio-trophoblast fragments, (IHC positive to hPL and β-HCG) present in the pulmonary capillaries were apparently a collateral histopathological finding. Although the histopathological, histochemical and microbiological data suggested the idea of a disseminated intravascular coagulation in the context of a septic shock syndrome, the presence of multiple syncytio-trophoblast fragments in the pulmonary capillaries cannot be completely dismissed as a incidental finding, having no contribution to the pathologic chain of events leading to the death of the patient.