Maternal death following cardiopulmonary collapse after delivery: Amniotic fluid embolism or septic shock due to intrauterine infection?

  • Romero R
  • Kadar N
  • Vaisbuch E
 et al. 
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The amniotic fluid embolism (AFE) syndrome is a catastrophic
complication of pregnancy frequently associated with maternal death. The
causes and mechanisms of disease responsible for this syndrome remain
Method of study
We report two cases of maternal deaths attributed to AFE: (1) one woman
presented with spontaneous labor at term, developed intrapartum fever,
and after delivery had sudden cardiovascular collapse and disseminated
intravascular coagulation (DIC), leading to death; (2) another woman
presented with preterm labor and foul-smelling amniotic fluid, underwent
a Cesarean section for fetal distress, and also had postpartum
cardiovascular collapse and DIC, leading to death.
Of major importance is that in both cases, the maternal plasma
concentration of tumor necrosis factor-alpha at the time of admission to
the hospital and when patients had no clinical evidence of infection was
in the lethal range (a lethal range is considered to be above 0.1
We propose that subclinical intraamniotic infection may be a cause of
postpartum cardiovascular collapse and DIC and resemble AFE. Thus, some
patients with the clinical diagnosis of AFE may have infection/systemic
inflammation as a mechanism of disease. These observations have
implications for the understanding of the mechanisms of disease of
patients who develop cardiovascular collapse and DIC, frequently
attributed to AFE. It may be possible to identify a subset of patients
who have biochemical and immunological evidence of systemic inflammation
at the time of admission, and before a catastrophic event occurs.

Author-supplied keywords

  • Bacteremia
  • Cardiorespiratory arrest
  • Chorioamnionitis
  • Disseminated intravascular coagulation
  • Fever
  • Intraamniotic infection
  • Pregnancy
  • Preterm labor
  • Tumor necrosis factor-α

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  • Roberto Romero

  • Nicholas Kadar

  • Edi Vaisbuch

  • Sonia S. Hassan

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