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Placental mesenchymal dysplasia complicated with sudden fetal demise and amniotic fluid embolism: a case report

BACKGROUND: Placenta mesenchymal dysplasia (PMD) is a rare placental anomaly associated with various fetal and maternal complications. Whether close ultrasound surveillance can prevent intrauterine fetal demise (IUFD) in patients with PMD is still under investigation. Amniotic fluid embolism (AFE) i...

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Autores principales: Wang, Shao-Jing, Lin, Li-Ling, Chen, Wei-Chih
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9733268/
https://www.ncbi.nlm.nih.gov/pubmed/36494789
http://dx.doi.org/10.1186/s12884-022-05261-2
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author Wang, Shao-Jing
Lin, Li-Ling
Chen, Wei-Chih
author_facet Wang, Shao-Jing
Lin, Li-Ling
Chen, Wei-Chih
author_sort Wang, Shao-Jing
collection PubMed
description BACKGROUND: Placenta mesenchymal dysplasia (PMD) is a rare placental anomaly associated with various fetal and maternal complications. Whether close ultrasound surveillance can prevent intrauterine fetal demise (IUFD) in patients with PMD is still under investigation. Amniotic fluid embolism (AFE) is a rare, lethal, and unpredictable maternal complication that has never been described in association with PMD. Here, we report a case of PMD, in which the fetus eventually demised in utero despite weekly color Doppler monitoring, and the mother subsequently encountered AFE during delivery. CASE PRESENTATION: A 43-year-old woman who had received three frozen embryo transfer, was found to have a singleton pregnancy with an enlarged multi-cystic placenta at 8 weeks’ gestation. Fetal growth restriction (FGR) was noted since the 21(st)week. The fetus eventually demised in-utero at 25 weeks despite weekly color Doppler surveillance. Cesarean section was performed under general anesthesia due to placenta previa totalis and antepartum hemorrhage. During surgery, the patient experienced a sudden blood pressure drop and desaturation followed by profound coagulopathy. AFE was suspected. After administration of inotropic agents and massive blood transfusion, the patient eventually survived AFE. PMD was confirmed after pathological examination of the placenta. CONCLUSIONS: While FGR can be monitored by color Doppler, our case echoed previous reports that IUFD may be unpreventable even under intensive surveillance in PMD cases. Although AFE is usually considered unpredictable, PMD can result in cumulative risk factors contributing to AFE. Whether a specific link exists between the pathophysiology of PMD and AFE requires further investigation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-022-05261-2.
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spelling pubmed-97332682022-12-10 Placental mesenchymal dysplasia complicated with sudden fetal demise and amniotic fluid embolism: a case report Wang, Shao-Jing Lin, Li-Ling Chen, Wei-Chih BMC Pregnancy Childbirth Case Report BACKGROUND: Placenta mesenchymal dysplasia (PMD) is a rare placental anomaly associated with various fetal and maternal complications. Whether close ultrasound surveillance can prevent intrauterine fetal demise (IUFD) in patients with PMD is still under investigation. Amniotic fluid embolism (AFE) is a rare, lethal, and unpredictable maternal complication that has never been described in association with PMD. Here, we report a case of PMD, in which the fetus eventually demised in utero despite weekly color Doppler monitoring, and the mother subsequently encountered AFE during delivery. CASE PRESENTATION: A 43-year-old woman who had received three frozen embryo transfer, was found to have a singleton pregnancy with an enlarged multi-cystic placenta at 8 weeks’ gestation. Fetal growth restriction (FGR) was noted since the 21(st)week. The fetus eventually demised in-utero at 25 weeks despite weekly color Doppler surveillance. Cesarean section was performed under general anesthesia due to placenta previa totalis and antepartum hemorrhage. During surgery, the patient experienced a sudden blood pressure drop and desaturation followed by profound coagulopathy. AFE was suspected. After administration of inotropic agents and massive blood transfusion, the patient eventually survived AFE. PMD was confirmed after pathological examination of the placenta. CONCLUSIONS: While FGR can be monitored by color Doppler, our case echoed previous reports that IUFD may be unpreventable even under intensive surveillance in PMD cases. Although AFE is usually considered unpredictable, PMD can result in cumulative risk factors contributing to AFE. Whether a specific link exists between the pathophysiology of PMD and AFE requires further investigation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-022-05261-2. BioMed Central 2022-12-09 /pmc/articles/PMC9733268/ /pubmed/36494789 http://dx.doi.org/10.1186/s12884-022-05261-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Wang, Shao-Jing
Lin, Li-Ling
Chen, Wei-Chih
Placental mesenchymal dysplasia complicated with sudden fetal demise and amniotic fluid embolism: a case report
title Placental mesenchymal dysplasia complicated with sudden fetal demise and amniotic fluid embolism: a case report
title_full Placental mesenchymal dysplasia complicated with sudden fetal demise and amniotic fluid embolism: a case report
title_fullStr Placental mesenchymal dysplasia complicated with sudden fetal demise and amniotic fluid embolism: a case report
title_full_unstemmed Placental mesenchymal dysplasia complicated with sudden fetal demise and amniotic fluid embolism: a case report
title_short Placental mesenchymal dysplasia complicated with sudden fetal demise and amniotic fluid embolism: a case report
title_sort placental mesenchymal dysplasia complicated with sudden fetal demise and amniotic fluid embolism: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9733268/
https://www.ncbi.nlm.nih.gov/pubmed/36494789
http://dx.doi.org/10.1186/s12884-022-05261-2
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