Aiist. N.Z.J. Obstet. Gynaec. (1979) 19: 176
Matthew Baillie - A Possible Early Description of Amniotic Fluid Embolism H. D. Attwood* Austin Hospital, Heidelberg
Amniotic fluid embolism is a histologically defined entity and an accepted cause of sudden maternal death. In the absence of histological examination of the lungs, the diagnosis can never be proven, but
other clinical and pathological evidence can justify such an assumption. T believe Matthew Baillie (1761-1823) examined a woman who had died from amniotic fluid embolism and my evidence is the substance of this short paper. Amniotic fluid can enter the maternal circulation if there is a breach in the membranes and an associated tear in the myometrium or placenta which opens maternal venous sinuses. Many portals of entry have been described, but a particular study of the association between amniotic fluid embolism and uterine tears was made by Attwood and Rome (1973) and Attwood (1975) in which the importance of small incomplete uterine tears and amniotic fluid embolism was emphasied. If such a tear exists and is bare of membranes when the head is low enough in the pelvis to block the ready egress of fluid through the cervix, then the uterine contraction forces the fluid into the exposed maternal veins. Just such a tear (figure 1 ) was photographed during a post mortem on a woman who died suddenly before delivery at the Royal Women’s Hospital, Melbourne, in 1964 (Smibert, 1967).
*
Postal Address: Professor H. D. Attwood, University Department of Pathology, Austin Hospital, Heidelberg, Vic. 3084.
The above tear bears a close resemblance to the descriptions given in “The Works of Matthew Baillie”, Vol. 1 (1 825). Page 229 : “Dissection of an impregnated uterus. I was called to a woman who had died suddenly
undelivered. She had not been dead more than half an hour before I came, and it was proposed that the uterus should be opened to recover the child, if possible. An incision was made through the length of the uterus before, and the child with the placenta removed. The child’s head had passed a considerable way into the cavity of the pelvis. Some means were used to restore animation in the child but they were unsuccessful. On the left side of the uterus there was a rupture near the round ligament, halfway between the fundus and the 0s uteri, with a quantity of coagulated blood. The blood was lodged between the rupture and the peritoneum. The abdomen was very pendulous. The uterus contracted to one half of its natural size after it was taken out of the body: a proof of its muscularity. On its surface, near the round ligaments were seen small absorbent vessels directed toward the Fallopian tubes.” and on p. 230: “Dissection of an impregnated uterus. I was present at the opening of a woman who had died suddenly undelivered. Her belly was exceedingly projecting and pendulous, being in her 13th pregnancy, On the left side, near the round ligament, and half way between the fundus and the cervix uteri there was a rupture two inches in length, and a great quantity of coagulated blood between the uterus and peritoneum. This rupture was not in the way of pressure, and therefore could only arise
H. D. ATTWOOD
177
Figure 1 . Lower uterine tear, bare of membranes, through which lethal amniotic fluid embolism occurred as the head was crowning. (From Smibert, Aust. N.Z. J . Obstet. Ciynaec. (1967).)
from the efforts of the uterus contracting on the child being carried beyond the strength of the uterus.” The similarities in the dcacription might suggest double reporting of the one example; however, the tear or tears described are similar t o the example of Smibert (1967) in position and size, and the fact that the peritoneum was not torn. The woman/ women described by Baillie died suddenly before delivery just ;IS the woman :it the Royal Women’s Hospital did in 1964. The woman 1 examined had his to1ogic a I1 y pro vcn amniotic fl LI i d embolism which
had caused her death. I submit that it is likely that the woman/women Matthew Baillie examined in 1789 also died from this rare complication. K c f wonces Attwood, H . 11. ( 1 975), “Pulmonary Pathology Decennial 1966 - 1975”, p. 71 - 99. Appleton-Century-Crofts, New York. AttMood, H . D., and Rome, R. M. (1963), Aust. N . Z . 1. O h , \ l C l Gytluec., 3: 73. Baillie, M. (1825), “The Works of Matthew Baillie”, Vol. I , pp. 229 a n d 230. Longman, Hurst, Rees, Orme, Brown and Gr-ecn, London. Smibert, J . (1967), A l r \ t . N . Z . J . ObJtet. Gyrzaec., 7: 1 .
Matthew Baillie - A Possible Early Description of Amniotic Fluid Embolism H. D. Attwood* Austin Hospital, Heidelberg
Amniotic fluid embolism is a histologically defined entity and an accepted cause of sudden maternal death. In the absence of histological examination of the lungs, the diagnosis can never be proven, but
other clinical and pathological evidence can justify such an assumption. T believe Matthew Baillie (1761-1823) examined a woman who had died from amniotic fluid embolism and my evidence is the substance of this short paper. Amniotic fluid can enter the maternal circulation if there is a breach in the membranes and an associated tear in the myometrium or placenta which opens maternal venous sinuses. Many portals of entry have been described, but a particular study of the association between amniotic fluid embolism and uterine tears was made by Attwood and Rome (1973) and Attwood (1975) in which the importance of small incomplete uterine tears and amniotic fluid embolism was emphasied. If such a tear exists and is bare of membranes when the head is low enough in the pelvis to block the ready egress of fluid through the cervix, then the uterine contraction forces the fluid into the exposed maternal veins. Just such a tear (figure 1 ) was photographed during a post mortem on a woman who died suddenly before delivery at the Royal Women’s Hospital, Melbourne, in 1964 (Smibert, 1967).
*
Postal Address: Professor H. D. Attwood, University Department of Pathology, Austin Hospital, Heidelberg, Vic. 3084.
The above tear bears a close resemblance to the descriptions given in “The Works of Matthew Baillie”, Vol. 1 (1 825). Page 229 : “Dissection of an impregnated uterus. I was called to a woman who had died suddenly
undelivered. She had not been dead more than half an hour before I came, and it was proposed that the uterus should be opened to recover the child, if possible. An incision was made through the length of the uterus before, and the child with the placenta removed. The child’s head had passed a considerable way into the cavity of the pelvis. Some means were used to restore animation in the child but they were unsuccessful. On the left side of the uterus there was a rupture near the round ligament, halfway between the fundus and the 0s uteri, with a quantity of coagulated blood. The blood was lodged between the rupture and the peritoneum. The abdomen was very pendulous. The uterus contracted to one half of its natural size after it was taken out of the body: a proof of its muscularity. On its surface, near the round ligaments were seen small absorbent vessels directed toward the Fallopian tubes.” and on p. 230: “Dissection of an impregnated uterus. I was present at the opening of a woman who had died suddenly undelivered. Her belly was exceedingly projecting and pendulous, being in her 13th pregnancy, On the left side, near the round ligament, and half way between the fundus and the cervix uteri there was a rupture two inches in length, and a great quantity of coagulated blood between the uterus and peritoneum. This rupture was not in the way of pressure, and therefore could only arise
H. D. ATTWOOD
177
Figure 1 . Lower uterine tear, bare of membranes, through which lethal amniotic fluid embolism occurred as the head was crowning. (From Smibert, Aust. N.Z. J . Obstet. Ciynaec. (1967).)
from the efforts of the uterus contracting on the child being carried beyond the strength of the uterus.” The similarities in the dcacription might suggest double reporting of the one example; however, the tear or tears described are similar t o the example of Smibert (1967) in position and size, and the fact that the peritoneum was not torn. The woman/ women described by Baillie died suddenly before delivery just ;IS the woman :it the Royal Women’s Hospital did in 1964. The woman 1 examined had his to1ogic a I1 y pro vcn amniotic fl LI i d embolism which
had caused her death. I submit that it is likely that the woman/women Matthew Baillie examined in 1789 also died from this rare complication. K c f wonces Attwood, H . 11. ( 1 975), “Pulmonary Pathology Decennial 1966 - 1975”, p. 71 - 99. Appleton-Century-Crofts, New York. AttMood, H . D., and Rome, R. M. (1963), Aust. N . Z . 1. O h , \ l C l Gytluec., 3: 73. Baillie, M. (1825), “The Works of Matthew Baillie”, Vol. I , pp. 229 a n d 230. Longman, Hurst, Rees, Orme, Brown and Gr-ecn, London. Smibert, J . (1967), A l r \ t . N . Z . J . ObJtet. Gyrzaec., 7: 1 .
