McA. Ledingham, M.B.,Ch.B. ; T. I.
McBride, M.B., M.R.C.P.; W. B. Jennett, M.D.; F.R.C.S. Brit. Med.
On 26 December 1966, a 22 year-old Prim Para in
her 37th week was admitted to a maternity hospital for observation
because of a minor antepartum hemorrhage. While in bed at 6.50 p.m.
on 16th January 1967, she complained of pins and needles in her left
limb and abruptly became unconscious and cyanosed with sterorous
respiration. (Amniotic Embolism) Because of the marginal improvement
which had taken place in the patient's condition with 100% oxygen at
normal pressure, and because of the onset now of fetal distress (the
fetal heart rate had risen to 200/min and was irregular), it was
decided to assess the effect of oxygen administration at 2
atmospheres absolute. Before compression started the patient began
to have generalized convulsions, which became continuous in minutes.
Her condition deteriorated until death was thought to be imminent.
Following hyperbaric oxygenation at 2 ata there was a marked
improvement in the patient's condition: the blood pressure rose to
100/70 mm Hg and the periphery became warm and pink. The fetal heart
rate, which had been 220 and irregular immediately before
compression, fell to 165 and became regular. Caesarian section was
now performed, and preceded smoothly, though it was noted that the
uterus remained slightly cyanosed in spite of the high maternal
arterial oxygen tension. A normal live female child was born with an
Apgar score of 9.