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Case of the Week 290



What's the most likely diagnosis?

  • 37 year-old female in labor with hypotension and dyspnea

  1. Mitral valve prolapse
  2. Fat embolism
  3. Klebsiella pneumnoia
  4. Amniotic fluid embolism
  5. TB

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Answer:

 


4. Amniotic fluid embolism

 

 

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Amniotic Fluid Embolism


General Considerations
 

  • Rare and frequently fatal obstetrical emergency occurring in the mother most often during labor resulting in profound hypotension and dyspnea
  • Believed to be due to amniotic fluid, fetal cells and unknown substance(s) that are released into the maternal bloodstream due to a breach in the barrier between amniotic fluid and the maternal circulation
    • Such material is not found in the maternal circulation of all patients with the syndrome and many patients with out the syndrome have such materials recovered
  • Leads to an anaphylactoid reaction possibly mediated by the complement cascade


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