Larcan A, Lambert H, Brunel G, Laprévote-Heully M C, Claude D, Durand L
J Gynecol Obstet Biol Reprod (Paris). 1981;10(1):67-73.
This is case history of a primigravid woman on whom Caesarean section was carried out in normal conditions for fetal distress, the patient being placed in Trendelenburg position. After the abdomen had been closed there was a sudden collapse with cyanosis, right bundle branch block and then coma with hypertonicity, hyperreflexia and transitory hemiplegia. The only possible diagnosis that could be made was of air embolus following Caesarean section in the light of many investigations that were carried out and the improvement under hyperbaric oxygen treatment and the very irregular progress of the neurological symptoms. Published case histories are rare [12] (published by Walrop, 1953 and Nelson 1960) and over all the result has been unfavourable. The diagnosis can be proven when gas has been found in the blood vessels at autopsy or by the finding of certain clinical signs which indicate the presence of air in the heart or in the blood vessels (water mill sound and the sound of air in the blood vessels). Diagnosis is made by exclusion. The differential diagnosis must be made with amniotic fluid embolus and the other cerebro-vascular accidents, as well as obstetrical shock. The principal factors that bring about air embolus are the entry of air into the dilated uterine veins which is helped by the negative pressure achieved by the Trendelenburg position. As soon as this diagnosis is made it is important to start hyperbaric oxygen treatment and symptomatic resuscitation.
