The pregnancy, the 35-Year-old is not without complications. In the 16. Week, a Test revealed that she has developed gestational diabetes.
The Doctors recommend the obese patient, their nutrition and move more. She does not smoke, does not drink alcohol and has no known allergies. Five years ago, she has already brought to a child by caesarean. Two more pregnancies she has terminated with abortions.
In the 18. Week an ultrasound shows that the placenta blocks the exit of the uterus. In the case of such a so-called placenta previa totalis must be delivered via caesarean section, without this intervention, both mother and Baby at birth, in great danger would be.
Other Tests show no abnormalities. The woman is advised to seek immediate medical attention if you have bleeding. These occur twice, and twice she goes for several days in a clinic in the U.S. state of Massachusetts. The Emperor will cut for the fourth day of the 37. Pregnancy week scheduled.
The woman loses consciousness
As the woman comes for the engagement in the Massachusetts General Hospital in Boston, she’s good. She has no pain, no contractions, no bleeding.
The patient receives a combined Spinal and epidural anesthesia, the sensation of pain in the abdominal area for the OP to turn off. In addition, you will be administered an antibiotic, the infections can be avoided.
The medical team performs the C-section as planned, 37 minutes after administering the Anesthetic the child is there. The Doctors to reduce the visibility protection, so that the mother can see her Baby, they report in the journal “NEJM”.
However, three minutes later, while the doctors clean the uterus, which occurs suddenly, while bleeding only slightly. At the same time the Doctors noted that the woman loses consciousness. Breathing only sporadically. The doctors intervene immediately and ventilate the woman.
Two minutes later, the woman has no pulse. Although the heart currents flow more, like the Doctors on the Monitor will be able to see, not pumping the Organ obviously correct. The physicians start with a cardio-pulmonary-resuscitation and intubate the patient for a constant ventilation.
It begins, massive bleeding
About a half hour later, the drama of the condition escalate: The woman begins to bleed profusely, it flows out of the cut on the operating table. You will lose in a short period of time, approximately two liters of blood to the uterus.
To go through already at the beginning of the heart-lung resuscitation, the Doctors in a rush all of the possible diagnoses that could underlie the critical condition of the patient.
She has a pulmonary embolism suffered a blockage of an artery in the Respiratory organs? The woman has some risk factors, including the pregnancy itself and your excess weight. Nevertheless, the physicians, the diagnosis is unlikely, because during the C-section you will have compression bandages on the legs of the formation of a deep vein thromobose prevented, and such blood clots are the ones with the blood circulation in the arteries of the lungs flushed and clog them. Against the diagnosis that the patient had no typical symptoms such embolism – such as chest pain or difficulty breathing -before she became unconscious.
An air embolism, when a blood vessel by a clot, but by a bubble of air, clogged, close, because here, too, probably would have been that the woman, among other things, first of all, caught my breath would have.
Sure are the Doctors that the circulatory collapse is not due to heavy blood loss has been triggered. Because as the woman lost consciousness, was the uterus and even poor circulation and there was no excessive blood loss. Also an allergic shock due to one of the drugs used to keep you for the reason.
Against a heart attack is that the rhythm of the institution, according to Monitor was normal, as the woman, have no pulse had.
Extremely rare complication
The Doctors still close to some of the other causes, to a very rare, life-threatening birth complication as the diagnosis remains the same: The woman has an amniotic fluid embolism. This occurs in approximately two to eight out of 100,000 births.
With a SIP of echo, an ultrasound examination of the heart through the esophagus inserted probe, can be confirmed by the Doctors, that the condition of the heart corresponds to the expected in the case of an amniotic fluid embolism.
This occurs when the amniotic fluid is penetrated into the bloodstream. Still is not resolved to the last Detail, what various processes are set in motion. It is clear, however, that the blood vessels in the lungs together, so that the pressure in the circulatory system of the lung is greatly increased, putting a burden on the right Heart. It extends – and failed mostly. Then, the left half of the Heart often fails. Because in addition to disturb substances from the amniotic fluid, the blood clotting, there is often massive bleeding.
The prognosis in the case of an amniotic fluid embolism is bad: In the US, 20 percent to 60 percent of the Affected die, it is said in the case report.
Because of the massive bleeding of the uterus, the Doctors will remove the Organ. The woman was in a stable condition, you would do everything to get the uterus, but in this emergency situation could cost you the minutes used on the life. Then, they manage to control the bleeding, also using certain drugs.
Just under three hours, the Doctors are fighting intensely to the life of the woman. Then, finally, her condition is stabilizing. Already two days after the event, you can leave the ICU after five days, the woman and her child home.