pituitrin and Fetal-Death

Describe the diagnosis, clinical features, pathophysiology, treatment and anesthetic management of amniotic fluid embolism (AFE) in a patient undergoing second trimester pregnancy termination.. A 30-yr-old gravida 2, para 1, woman was admitted for a dilatation and evacuation procedure for underlying intra-uterine fetal demise in her second trimester of pregnancy. Hypotension, shock, respiratory arrest, pulseless electrical activity, hemorrhage, disseminated intravascular coagulopathy, requiring cardiopulmonary resuscitation and blood transfusion complicated her intraoperative care. AFE was considered the most likely cause of this intraoperative event.. It is now recognized that the pathophysiological features of AFE are similar to a type-1 hypersensitivity reaction ranging from mild systemic reaction to anaphylaxis and shock. AFE has a high maternal and fetal morbidity and mortality rate, requiring prompt recognition and treatment. In patients with cardiovascular instability, the treatment of AFE is similar to anaphylaxis requiring aggressive fluid hydration, cardiopulmonary resuscitation, administration of blood products and the use of vasopressors.

Topics: Adult; Anesthesia, Obstetrical; Anesthetics, Intravenous; Anesthetics, Local; Cardiopulmonary Resuscitation; Dilatation and Curettage; Embolism, Amniotic Fluid; Female; Fentanyl; Fetal Death; Hemodynamics; Humans; Intubation, Intratracheal; Mepivacaine; Midazolam; Monitoring, Intraoperative; Oxygen; Pregnancy; Pregnancy Trimester, Second; Propofol; Vasoconstrictor Agents; Vasopressins

The role of hyperthermia in the absence of infection has been investigated in the pregnant baboon. Twenty-three near term animals were used. Catheters were placed in maternal and fetal arteries and thermocouples implanted in maternal colon and fetal esophagus. Maternal temperature was raised to between 41 and 42 degrees Centigrade (C.), by applying external heat. The temperature gradient between fetus and mother (delta T F-M) was 0.47 degree C. under steady-state conditions with maternal temperature at 38 degrees C. and rose to 0.75 degree C. at 42 degrees C. Hyperthermia caused a twofold increase in uterine activity; a metabolic acidosis developed in the mother and a profound acidosis and hypoxia developed in the fetus. There was also a marked fall in blood pressure and an increase in heart rate in both mother and fetus; late deceleration of the fetal heart rate occurred at a higher oxygen level and pHa than has been observed under normothermic conditions.

Topics: Acidosis; Animals; Arrhythmias, Cardiac; Body Temperature; Female; Fetal Death; Fetal Diseases; Fetal Heart; Fever; Haplorhini; Heart Rate; Hypotension; Hypoxia; Labor, Obstetric; Oxytocin; Papio; Pregnancy; Pregnancy Complications; Vasopressins

Topics: Animals; Delivery, Obstetric; Fallopian Tubes; Female; Fetal Death; Injections, Intravenous; Labor, Induced; Ligation; Methods; Muscle Contraction; Oxytocin; Pregnancy; Pregnancy, Animal; Rabbits; Time Factors; Uterus; Vasopressins

Topics: Abnormalities, Drug-Induced; Angiotensin II; Animals; Epinephrine; Female; Fetal Death; Humans; Infant, Newborn; Isoproterenol; Maternal-Fetal Exchange; Mice; Norepinephrine; Placenta; Pregnancy; Rabbits; Rats; Serotonin; Vasopressins