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Chapter 19 - Air Embolism Related to Sex in Pregnancy and the Postpartum

from Section 2 - Specific Issues

Published online by Cambridge University Press:  09 November 2022

By
Dina Mohamed ,
Mohamed Momtaz  and
Dan Farine
Edited by
Dan Farine  and
Pablo Tobías González
Dan Farine
Affiliation:
Mount Sinai Hospital, Toronto
Pablo Tobías González
Affiliation:
Hospital Universitario Infanta Cristina de Parla, Madrid
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Summary

Air embolism is acute embolism resulting from vaginal insufflation. It was first reported in 1936. There is no definite report of its incidence, but has been described in 18 mortalities out of 20 million pregnancies. When air is introduced under pressure, it travels through the dilated cervical canal and beneath the amniotic membranes, to enter the subplacental sinuses. Once air enters the venous drainage of the uterus, it reaches the inferior vena cava, and from there to the right side of the heart. Patients with venous air embolism (VAE) may present with a wide variety of symptoms. The most serious manifestation of VAE is out-of-hospital cardiac arrest. Laboratory abnormalities vary according to the severity of the embolism but lack specificity. The first line of treatment is advising pregnant females against orogenital sex with air insufflation. Accurate diagnosis is the key for managing VAE. Management starts with administration of 100% oxygen, then turning the patient onto her left side in a head-down position. In case of cardiovascular collapse, closed-chest compression is used to remove air trapped in the right side of the heart. Hyperbaric oxygen therapy has been proved to be an effective therapy as well.

Keywords

cardiac arresthyperbaric oxygenorogenital sexvaginal insufflationvenous air embolism
Type
Chapter
Information
Sex and Pregnancy
From Evidence-Based Medicine to Dr Google
 , pp. 138 - 143
Publisher: Cambridge University Press
Print publication year: 2022

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