Amniotic fluid embolism: case report and literature review

Amniotic fluid embolism (AFE) is a rare but fatal syndrome occurring mostly during delivery or immediately postpartum. We report the case of a 33-year-old patient with no significant medical history. Coinciding with the rupture of the amniotic sac, the patient experienced dizziness that improved in the left lateral position with fluid therapy. Cardiac arrest occurred after delivery. After 45 min of cardiopulmonary resuscitation, the patient recovered but developed an atonic postpartum hemorrhage reversible with methylergometrine and misoprostol and the placement of a Bakri balloon. Disseminated intravascular coagulation was suspected and the patient was transfused with eight packs of red blood cells, three plasma concentrates and 2000 IU of Octaplex. The patient was then transferred to our hospital and admitted to the intensive care unit with a suspected diagnosis of AFE. On admission, she showed active metrorrhagia and hematuric urine, hemoglobin levels of 7.9, thrombocytopenia and coagulopathy, requiring transfusion of packed red blood cells, 1 platelet pool, 750 ml of plasma, fibrinogen and clotting factor VII. After correction of the coagulopathy, the bleeding stopped and the patient was discharged 6 days later. (C) 2012 Elsevier Espana, S.L. All rights reserved.