Case 40-2012: A Woman with Cardiorespiratory Arrest after a Cesarean Section

New England Journal of Medicine (Impact Factor: 55.87). 03/2013; 368(13):1260-1261. DOI: 10.1056/NEJMc1301068#SA1
Source: PubMed


To the Editor: In the Case Record presented by Ecker et al. (Dec. 27 issue),(1) the presumptive clinical diagnosis of amniotic-fluid embolism was supported by transesophageal echocardiography. The pattern described, however, is typical of any large acute embolism and severe pulmonary hypertension.(2)-(4) In this patient, air embolism and thrombotic embolism are not completely ruled out, and echocardiography alone is not sufficient to discriminate among the various forms. In fact, the patient was readmitted to the hospital for multiple pulmonary embolism, and the beneficial treatment with heparin during extracorporeal membrane oxygenation suggests thromboembolic disease as the most likely diagnosis. Amniotic-fluid . . .

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