Iatrogenic Cardiac Tamponade During Pregnancy

EDITORIAL COMMENT: Reports in the literature during the past 15 years seem to have established that asymptomatic pericardial effusion is common in women with apparently normal pregnancies, especially in the third trimester. There seems to be no association with cardiac disease or preeclampsia. We accepted this case report to inform readers about the occurrence of pericardial effusion and to deliver the authors' warning that conservative management should be favoured. It is common, indeed usual, to see an accumulation of fluid in the peritoneal cavity at Caesarean section, especially when performed in labour when there is cephalopelvic disproportion. The editor has always assumed this to be a sign of obstructed labour due to transudation of fluid from peritoneum of the pelvis and bladder, perhaps due to obstructed lymphatics or increased venous pressure in compressed tissues. The members of the editorial committee remain puzzled concerning the aetiology of pericardial effusions in pregnancy. We hope to be offered a review of the problem to dispel our ignorance. The physiology of peritoneal fluid production in complicated and normal pregnancy also remains unexplained. (A) Calvin S, Silva M, Weinslein L, Finley P, Witse M. Characterization of ascites present at cesarean section. Am J Perinatal 1991: 8: 99–102. Summary: A 26‐year‐old primigravida who presented to us with threatened preterm labour which was suppressed successfully with sulindac, was found to have a pericardial effusion. Pericardiocentesis was performed because of evidence of right ventricular compression. However, it was complicated by inadvertant puncture of the left ventricle causing cardiac tamponade, and hypovolaemic shock shortly afterwards. An emergency pericardiotomy was performed to rescue the patient.