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Trophoblastic pulmonary embolism.

J C Smith, S A Alsuleiman, H Bishop

    Southern Medical Journal
    |August 1, 1981
    PubMed
    Summary
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    Trophoblastic embolism occurs in pregnancy, especially molar pregnancies, potentially causing acute respiratory distress. Management focuses on diuresis and ventilatory support to prevent heart failure.

    Area of Science:

    • Obstetrics and Gynecology
    • Pulmonary Medicine
    • Pathology

    Background:

    • Trophoblastic embolism is a known complication in pregnancy, varying in severity.
    • It is particularly significant in molar pregnancies, often presenting during uterine evacuation.
    • Acute respiratory distress syndrome (ARDS) is a recognized risk in these cases.

    Observation:

    • Pulmonary arteriolar blockage by trophoblastic emboli is a key pathological finding.
    • Pulmonary edema and right-sided heart strain are frequently observed.
    • Associated conditions include hyperthyroidism and fibrin deposition in alveoli.

    Findings:

    • Trophoblastic embolism can lead to self-limited acute respiratory distress in 3-10% of molar pregnancies.
    • Pathogenesis involves heart failure, hyperthyroidism, anemia, and pulmonary vascular obstruction.

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  • Fluid and blood infusions can exacerbate pulmonary overload and precipitate heart failure.

    • Implications:

    • Prompt recognition and management of trophoblastic embolism are crucial.
    • Therapeutic strategies should prioritize diuresis and ventilatory support.
    • Oxygen therapy with positive end-expiratory pressure (PEEP) is recommended for respiratory support.