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J Cases Obstet Gynecol, 2017;4(4):84-86


            J o u r n a l   o f   C a s e s   i n                                                                                     J o u r n a l   o f   C a s e s   i n
            Obs tetrics & G ynecology                                                                                                 Obs tetrics & G ynecology
                                                                                                                                   Case Report


        with a right-sided pneumothorax should be evaluated for   endometriosis is increasing considered to be a clinical di-
        endometriosis, especially if significant pelvic symptomatol-  agnosis [23], in woman investigated  with laparoscopy,       Near Miss Postpartum Woman with an Amniotic Fluid Embolism, a Rari-
        ogy is present.  The overlap between pelvic and thoracic en-  scrupulous inspection of the diaphragm is warranted even     ty Requiring Multidisciplinary Approach
        dometriosis cannot be overstated.  In a retrospective review   if in the absence of a history of thoracic symptoms as this
        of 156 women with women with pneumothorax, pelvic en-   may identify some women at risk of future pneumothorax.
        dometriosis symptoms were significantly more common in
        those found to have thoracic endometriosis [14].  In symp-  Acknowledgement                                                Natalia Hanson¹*, Christopher Heron¹, Emil R. Szabo²
        tomatic women who went on to laparoscopy, 80% had con-  None
        firmed pelvic endometriosis.  Moreover, if surgical man-  Declaration of Interest                                          1 Department of Family Medicine, Penn State Health Milton S. Hershey Medical Center, Mount Nittany Medical Center,1850 East Park Ave, Suite 207, State College,
        agement is undertaken, gynecologic consultation should be   R.L.R has been consultant to Allergan, Aspen and Bayer and has served   PA, 16803, United States
                                                                                                                                   2
                                                                                                                                   Department of Obstetrics- Gynecology, Solo Practitioner, 251 Easterly Parkway, State College, PA, 16801, United States
        considered both intraoperatively and in follow up.  While   on the Data and Safety Monitoring Board for Merck.
                                                                                                                                   Abstract
                                                                                                                                   An amniotic fluid embolism (AFE) is a condition with one of the highest pregnancy- associated mortality rates, accounting for 5-15% of pregnancy-re-
                                                                                                                                   lated deaths worldwide. This article describes a case of a 36- year- old G4P1 at 38 weeks of gestation who underwent a planned Cesarean section for
                                                                                                                                   a placenta previa which was complicated by cardiac arrest and disseminated intravascular coagulopathy secondary to a suspected AFE. The patient
                                                                                                                                   was treated with a multidisciplinary approach, rapid response to alterations in vital stability and factor VII. The unpredictable nature of AFE and the
                                                                                                                                   gravity of its sequelae warrant high suspicion in those at risk for AFE, as early recognition and prompt treatment can improve morbidity and mortality.


                                                                                                                                   Key Words:
        References                                                                                                                 Amniotic fluid embolism, disseminated intravascular coagulation, vaginal bleeding, factor VII


        1.  Missmer ST, Cramer DW.  The epidemiology of endome-  sis. J Minim Invasive Gynecol 2006;13:566-572  sis. Recurrence following hysterectomy with bilateral
        triosis. Obstet Gynecol Clin North Am 2003;30(1):1-19.  11.  Clayton R, Hawe J, Love J,  Wilkinson N, Garry   salpingo-oophorectomy and successful treatment
        2.  Hilaris GE, Payne CK, Osias J, Cannon W, Nezhat   R. Recurrent pain after hysterectomy and bilateral   with talc pleurodesis. Chest 2014;106(6):1894–6.
        CR. Synchronous rectovaginal, urinary bladder, and   salpingo-oophorectomy for endometriosis: eval-  19.  Subotic D, Mikovic Z, Atanasijadis N, Savic M,   Introduction            Case Presentation
        pulmonary  endometriosis.  JSLS  2005;9(1):78–82.   uation of laparoscopic excision of residual endo-  Moskovljevic D. Hormonal therapy after the oper-
        3. Sampson JA.  The development of the im-  metriosis. Br J Obstet Gynaecol 1999;106:740-4.  ation for catamenial pneumothorax - is it always
        plantation theory for the origin of peritone-  12.  Visouli AN, Darwiche K, Mpakas A, Zarogoulidis   necessary? J Cardiothorac  Surg 2016;11(1):66.   An amniotic fluid embolism (AFE) is a rare condition with   A 36-year-old G4P1 patient at 38-weeks of gestation
        al  endometriosis.  AJOG  1940;40(4):549–57.  P, Papagiannis A, Tsakiridis K, et al. Catamenial pneu-  20. Granese R, Perino A, Calagna G, Saitta S, De Fran-                      presented for a scheduled cesarean section for complete
        4. Gruenwald P. Origin of endometriosis from the mes-  mothorax: a rare entity? Report of 5 cases and review   ciscis P, Colacurci N, et al. Gonadotropin-releasing   one of the highest mortality rates associated with pregnancy,
        enchyme of the celomic walls. AJOG 1942;44(3):470–4.   of the literature. J Thorac Dis 2012;4 Suppl 1:17–31.   hormone analogue or dienogest plus estradiol val-  accounting for approximately 5-15% of pregnancy related   placenta  previa.  She has one daughter born via sponta-
        5. Jerman LF, Hey-Cunningham AJ.  The Role of the   13. Blanco S, Hernando F, Gómez A, González   erate  to prevent pain recurrence after laparoscopic                             neous vaginal delivery and a history of two spontaneous
        Lymphatic System in Endometriosis: A Comprehensive   MJ,  Torres AJ, Balibrea JL. Catamenial pneumo-  surgery for endometriosis: a multi-center randomized   deaths worldwide [1,2,3]. These mortalities often result from
        Review  of the Literature. Biol  Reprod 2015;92(3):64.   thorax  caused by diaphragmatic  endometrio-  trial. Acta Obstet Gynecol Scand 2015;94(6):637–45.   AFE-induced cardiac arrest and disseminated intravascular   abortions. Her prenatal  screening was unremarkable  ex-
        6. Alwadhi S, Kohli S, Supreethi K, Gehlot   sis. J  Thorac Cardiovasc Surg 1998;116(1):179–80.   21.  Takaesu  Y, Nishi H, Kojima J, Sasaki  T, Nag-                              cept for non-immunity to rubella; she was group B strep
        K.  Thoracic  Endometriosis  -  A  Rare  Cause   14.  Rousset-Jablonski  C,  Alifano  M,  Plu-Bureau   amitsu  Y, Kato R, et al. Dienogest compared   coagulopathy (DIC). We examine a case of AFE in the setting
        of   Haemoptysis.  JCDR  2016;10(4):TD01–2.  G, Camilleri-Broet S, Rousset P, Regnard JF, et   with  gonadotropin-releasing  hormone  ago-  of primary hospitalization in order to review the evaluation   negative, O+ blood type, and Coombs negative. She
        7. Joseph J, Sahn SA.  Thoracic endometrio-  al.  Catamenial  pneumothorax  and endometri-  nist after conservative surgery for endometri-  and management of the condition, its complications, and   smoked less than five cigarettes per day during the preg-
        sis syndrome: new observations from an analy-  osis - related pneumothorax: clinical features   osis. J Obstet Gynaecol Res 2016;42(9):1152-8.                                     nancy and reported taking  Ambien for sleep. Her preg-
        sis of 110 cases. Am J Med 1996;100(2):164–70.   and  risk  factors.  Hum  Reprod  2011;26(9):2322–9.   22. Morelli M, Sacchinelli A, Venturella R, Mocciaro R,   to reiterate the importance of prompt recognition of AFE.
        8.  Marshall MB, Ahmed Z, Kucharczuk JC, Kai-  15.  Van-Schil   PE,  Vercauteren   SR,  Vermeire   Zullo  F.  Postoperative  administration  of  dienogest                         nancy course was unremarkable except for painless spot-
        ser  LR,  Shrager  JB.  Catamenial  pneumotho-  PA,  Nackaerts  YH,  Van-Marck  EA.  Catame-  plus estradiol valerate versus levonorgestrel-re-                                    ting which started during the second trimester secondary
        rax:  optimal  hormonal  and  surgical  manage-  nial pneumothorax caused by thoracic en-  leasing  intrauterine device for  prevention of  pain
        ment. Eur J Cardiothorac Surg 2005;27(4):662–6.    dometriosis. Ann  Thorac Surg 1996;62:585-6.  relapse and disease recurrence in endometriosis                                   to a complete placenta previa confirmed by ultrasound. A
        9.  Korom S, Canyurt H, Missbach A, Schnieter D, Kurrer   16. Shikino K, Ohira Y, Ikusaka M. Catamenial Pneu-  patients. J Obstet Gynaecol Res 2013;39(5):985–90.                  Cesarean section was scheduled, and given concerns for
        MO, Haller U, et al. Catamenial pneumothorax revis-  mothorax. J Gen Intern Med 2016;24(10):1260.   23.  Leyland N, Casper R, Laberge P, Singh SS, Al-
        ited: clinical approach and systematic review of the   17.  Hwang  SM,  Lee  CW,  Lee  BS,  Park  JH.  Clinical   len L, Arendas K, et al. Endometriosis: Diagno-                  postpartum complications, the procedure was moved to a
        literature. J  Thorac Cardiovasc Surg 2004;128:502-8.  features of thoracic endometriosis: A single cen-  sis and Management. JOGC  2010;32(7):S1–S3.   Article History:           larger operating room. Prior to the operation, blood values
        10.  Martin  CD.  Hysterectomy  for  treat-  ter analysis. Obstet Gynecol Sci 2015;58(3):223.                              Received: 11/07/2016
        ment  of  pain  associated  with  endometrio-  18. Joseph J, Reed CE, Sahn SA. Thoracic endometrio-                        Accepted: 21/07/2017                                    were as follows:  Hgb: 11.7, Hct: 35.3, PTT: 27.7, INR: 0.9
                                                                                                                                                                                           The  child  was born with an APGAR of 8/9 at  0804. At
                                                                                                                                   *Correspondence: Natalia Hanson
                                                                                                                                   Address: Penn State Health Milton S. Hershey Medical Center,   0805 the  patient  developed  seizure-like  activity  and be-
                                                                                                                                   Mount Nittany Medical Center,1850 East Park Ave, Suite 207, State   came  unresponsive.  She  was intubated,  received  Atro-
                                                                                                                                   College, PA, 16803, United States
                                                                                                                                   Tel: 8144241230
                                                                                                                                   Fax: 8142352482
                                                                                                                                    e-mail: nhanson@hmc.psu.edu
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               www.jcasesobstetgynecol.com                                                                 October 2017            Journal of Cases in Obstetrics & Gynecology
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