Universität zu Köln

Banaschak, Sibylle ORCID: 0000-0002-1413-1250, Janssen, Katharina, Becker, Katrin, Friedrich, Krischan and Rothschild, Markus A. (2014). Fatal postpartum air embolism due to uterine inversion and atonic hemorrhage. Int. J. Legal Med., 128 (1). S. 147 - 151. NEW YORK: SPRINGER. ISSN 1437-1596

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Abstract

We report a case of a 19-year-old woman who developed a persistent uterine hemorrhage after spontaneous delivery of a healthy child. Emergency laparotomy was indicated and then begun under stable circulatory conditions. Cardiac arrest occurred during the course of massive manual compression and packing of the uterus. After successful resuscitation, a supracervical hysterectomy was performed. During the suturing of the remaining cervix, a second cardiac arrest followed. The procedure was completed under constant external heart massage. Resuscitation was terminated due to the persistence of widened pupils. An autopsy was ordered by the public prosecutor as the manner of death was declared to be unascertained. An X-ray and a CT scan prior to the autopsy showed extensive gas embolism in both arterial and venous vessels extending from the pelvic region to the head. During the autopsy, gas was collected by aspirometer from the right ventricle of the heart. The autopsy showed no additional relevant findings, and gas analysis confirmed the suspicion of air embolism. The histological examination of the excised uterus especially in the corpus/fundus revealed an edema of the local smooth muscle cells and dilated vessels showing no sign of thrombogenesis. Upon evaluation of the clinical records, it became evident that, in addition to uterine atony, there had been a complete uterine inversion. This inversion was manually repositioned. After this maneuver, manual compression was performed. The air embolism, thus, was a complication of the manual repositioning of the uterine inversion. There is no evidence for other possible entries of the detected gas. In order to perform an effective exploration, the availability of all clinical records should be mandatory for medico-legal investigations of unexpected postpartum deaths.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Banaschak, Sibylle UNSPECIFIED orcid.org/0000-0002-1413-1250 UNSPECIFIED Janssen, Katharina UNSPECIFIED UNSPECIFIED UNSPECIFIED Becker, Katrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Friedrich, Krischan UNSPECIFIED UNSPECIFIED UNSPECIFIED Rothschild, Markus A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-451490
DOI:	10.1007/s00414-013-0826-7
Journal or Publication Title:	Int. J. Legal Med.
Volume:	128
Number:	1
Page Range:	S. 147 - 151
Date:	2014
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1437-1596
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Medicine, Legal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/45149