Medicine Student, Federal University of Paraná, Curitiba, Paraná, Brazil.
Department of Tocogynecology, Federal University of Paraná, Curitiba, Paraná, Brazil.
BMC Pregnancy Childbirth. 2024 Nov 14;24(1):752. doi: 10.1186/s12884-024-06969-z.
Heterotopic pregnancy and amniotic embolism are rare conditions that can be challenging to diagnose. To date, there are no cases of heterotopic pregnancy associated with amniotic embolism described in the literature. Therefore, we report the case of a pancreatic heterotopic pregnancy, which led to amniotic embolism and an unfavorable maternal outcome.
A 20-year-old pregnant woman presented with nausea and abdominal pain refractory to drug treatment. She had an increased lipase of 205 U/L (reference 8 to 78 U/L) and a total abdominal ultrasound with biliary sludge. The pregnant woman had no known risk factors for ectopic and heterotopic pregnancy. The initial diagnostic suspicions were hyperemesis gravidarum or acute pancreatitis. During hospitalization, she fluctuated between periods of clinical improvement and worsening of abdominal pain, but serial laboratory control had a favorable and benign evolution. On the 30th day of hospitalization, the patient developed spontaneous abortion, respiratory failure, and cardiorespiratory arrest. Necropsy showed heterotopic pregnancy in the pancreatic tail, amniotic embolism, and consequent disseminated intravascular coagulation.
Obstetricians should suspect heterotopic pregnancy in patients with an acute abdomen. The gold standard diagnostic method for this condition is laparoscopy. In the present case, the authors consider that pancreatic pregnancy allowed the introduction of fetal antigens and amniotic fluid into the maternal bloodstream, leading to amniotic embolism and consequent disseminated intravascular coagulation.
异位妊娠和羊水栓塞是罕见的疾病，诊断具有挑战性。迄今为止，文献中尚无羊水栓塞合并异位妊娠的病例描述。因此，我们报告了一例胰腺异位妊娠导致羊水栓塞和不良母婴结局的病例。
一名 20 岁孕妇因恶心和腹痛且药物治疗无效而就诊。她的脂肪酶升高至 205 U/L（参考范围 8 至 78 U/L），全腹部超声检查显示有胆泥。该孕妇无异位和异位妊娠的已知危险因素。最初的诊断怀疑是妊娠剧吐或急性胰腺炎。住院期间，她的腹痛在临床改善和恶化之间波动，但连续的实验室检查结果呈良性演变。住院第 30 天，患者发生自然流产、呼吸衰竭和心肺骤停。尸检显示胰腺尾部的异位妊娠、羊水栓塞和随后的弥散性血管内凝血。
妇产科医生应怀疑有急性腹痛的患者存在异位妊娠。该病症的金标准诊断方法是腹腔镜检查。在本病例中，作者认为胰腺妊娠使胎儿抗原和羊水进入母体血液，导致羊水栓塞和随后的弥散性血管内凝血。
