Venous air embolism. Life-threatening complication of orogenital sex during pregnancy

doi:10.1016/0002-9343(85)90445-0

The American Journal of Medicine

Volume 78, Issue 2, February 1985, Pages 333-336

https://doi.org/10.1016/0002-9343(85)90445-0 Get rights and content

Abstract

Vaginal insufflation in pregnant women leading to acute venous air embolism has been appreciated by obstetricians and pathologists for several decades. Initially described as a complication of powder insufflation for treatment of trichomal vaginitis, insufflation-induced air embolism has been more recently associated with orogenital sex. The case herein Illustrates a typical history that is almost pathognomonic. Clinical and laboratory abnormalities as well as treatment measures are briefly described. Familiarity with this syndrome is essential if prompt and appropriate therapy is to be rendered.

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Cited by (30)

Non-surgical pneumoperitoneum after oro-genital intercourse
2013, International Journal of Surgery Case Reports
In many cases, a pneumoperitoneum is due to air escaping from a perforated hollow viscus or surgical intervention but there are increasing reports of non-surgical causes.
We report a case where a pneumoperitoneum was identified after oro-genital sexual intercourse.
There were nineteen reported cases of non-surgical pneumoperitoneum from gynaecologic causes up to May 2013. We report an additional case four hours after oro-genital intercourse. Close clinical observation and symptomatic treatment are usually all that is required but operative interventions should be considered if the patient develops abdominal pain, peritoneal signs, fever or leukocytosis during observation.
This adds to the world literature on non-surgical pneumoperitoneum from oro-genital intercourse. Clinicians should be aware of this condition and focus on medical-sexual history as this information could prevent a patient from being exposed to expensive diagnostics and invasive operative treatments. Patients should also be educated about the mechanisms to avoid future possible diagnostic dilemmas.
Out-of-hospital cardiac arrest from air embolism during sexual intercourse: Case report and review of the literature
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Citation Excerpt :
In the out-of-hospital setting, VAE is a very infrequent cause of cardiac arrest with a high mortality rate as therapeutical possibilities are very limited compared with in-hospital cases. Predominating causal reasons are severe penetrating neck or thoracic injuries and sexual activities in pregnancy when air bubbles can pass through the impaired wall of the uterus and lead to blood flow obstruction under certain circumstances.1,5,6 The vagina is a highly distensible organ, especially in pregnancy, and has an immediate postpartum capacity up to 2000 ml.7,8
We report the successful resuscitation of a 38-year-old woman in cardiac arrest following heterosexual intercourse 7 days after spontaneous abortion and an instrumental uterine evacuation. The collapse was thought to be due to venous air embolism (VAE). Her survival neurologically intact was attributed to appropriate first aid, pre-hospital and subsequent hospital intensive care. Neither a case of an out-of-hospital air embolism where the patient made a good recovery, nor a case of miscarriage followed by collapse from air embolism has been reported in the literature. Air embolism is a very infrequent cause of out-of-hospital cardiac arrest with a high mortality rate. Predominant causal reasons are severe penetrating neck or thoracic injuries and sexual activities in pregnancy, when air can pass into the damaged veins in the wall of the uterus and lead to total obstruction in the heart. Diagnostics and management techniques for venous air embolism are discussed. Air embolism should be included in the differential diagnosis for all young women in cardiac arrest, particularly when occuring during sexual activity. Instructions in risks of sexual intercourse during pregnancy and the puerperium should become part of pregnant women's education.
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Venous air embolism following orogenital sex during pregnancy
1993, American Journal of Emergency Medicine
Venous air embolism is an infrequent complication of pregnancy but may occur if air is blown into the vagina during orogenital sex. Air passes beneath the fetal membranes and into the circulation of the subplacental sinuses, invariably causing death to both mother and fetus within minutes. Reported is the case of a nonfatal air embolism following vaginal air insufflation in the 38th week of pregnancy. The hospital course was complicated by hypotension, metabolic acidosis, acute neurologic changes, and emergency caesarean section with eventual fetal demise. Clinical and laboratory abnormalities as well as treatment measures are discussed. Familiarity with this syndrome is essential if prompt and appropriate therapy is to be rendered.

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Case reportVenous air embolism. Life-threatening complication of orogenital sex during pregnancy

Abstract

Lancet

Am J Surg

Am Heart J

J Surg Res

Orogenital sex as a cause of nonfatal air embolism in pregnancy

Obstet Gynecol

Antepartum air embolism

J Indiana State Med Assoc

Fatal air embolism in pregnancy resulting from an unusual sexual act

Obstet Gynecol

Death from air embolism during pregnancy (letter to the editor)

Obstet Gynecol

Death from vaginal insufflation

Can Med Assoc J

The third case of fatal air embolism reported after vaginal insufflation

Br Med J

Death from air embolism following insufflation during pregnancy

JAMA

Case report
Venous air embolism. Life-threatening complication of orogenital sex during pregnancy