Pulmonary Embolization by Chorionic Villi Causing Maternal Death After a Car Crash

Abstract

Throughout the last century, there has been a marked decline in obstetric maternal deaths, resulting in an increase in the proportion of nonobstetric deaths among pregnant women. Trauma, in particular, has become a leading cause of maternal death. We report the case of a 20-year-old primigravid woman who was involved in a motor vehicle crash at 36 weeks gestation. The woman developed abruptio placentae, followed by disseminated intravascular coagulation, adult respiratory distress syndrome, and shock, and died the day after the crash. Widespread pulmonary embolization by chorionic villi was identified at autopsy. This report discusses traumatic maternal deaths, with emphasis on the differences in injury pattern observed in pregnant trauma victims in comparison with other adults. It is important that the pathologist be aware of these problems so that an accurate cause of death can be identified in cases of maternal death after trauma. Also discussed is the relationship between trauma and placental abruption and the mechanism of death in the patient. To the authors' knowledge, this is the first reported case of extensive embolism of chorionic villi to the lungs after trauma.

The epidemiology of pregnancy-associated emergency department injury visits and their impact on birth outcomes

“…Although there have been many studies that focus on trauma during pregnancy (Aitokallio-Tallberg and Halmesmäki, 1997;Baerga-Varela et al, 2000;Bowman et al, 1989;Drost et al, 1990;El-Kady et al, 2004;Galle and Anderson, 1997;Greenblatt et al, 1997;Hartl and Ko, 1996;Kingston et al, 2003;Kissinger et al, 1991;Klinich et al, 2000;Kuo et al, 2007;Legros et al, 2000;LeSher and O'Connor, 1992;Metz and Abbott, 2006;Occelli et al, 1998;Rainio and Penttila, 2003;Sandy and Koerner, 1989;Schiff et al, 2001;Schiff and Holt, 2005;Sherer et al, 1993;Weiss, 1999;Williams et al, 1990), our study is the first to describe on a population basis the epidemiology of emergency department treated injured pregnant women. Most emergency department treated injured women are not hospitalized, thus studies that only include inpatient records are not looking at the whole picture.…”

Forensic aspects of post-mortem histological detection of amniotic fluid embolism

“…The histological visualisation of amniotic fluid debris in the uterine veins was only seldom successful [22][23][24] although it is obvious that amniotic fluid can gain entry into the maternal circulation only via uterine veins. In our study, the components of AF, decidual cells, as well as whole chorionic villi, were only detected in the uterine veins and in the pulmonary circulation in a woman with traumatic uterine rupture and placental separation [24,25].…”

Placental abruption: epidemiology, risk factors and consequences

“…The relatively elastic uterus is able to alter its shape in reaction to forces applied to the abdomen, whereas the less elastic placenta is not. A shearing effect disrupts the attachment of placenta to the decidua (92). American College of Obstetricians and Gynecologists recommends a minimum of 4 hours post‐trauma monitoring.…”