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Amniotic fluid embolism with isolated coagulopathy: a case report
Jeong-In Yang1, Haeng-Soo Kim, Ki-Hong Chang
1Department of Obstetrics and Gynecology, Ajou University School of Medicine, San-5, Wonchon-dong, Paldal-ku, Kyunggi-do, 443-749 Suwon, South Korea. yangji@madang.ajou.ac.kr
The Journal of Reproductive Medicine
|February 18, 2006
Summary
Amniotic fluid embolism can present atypically with hemorrhage, not just cardiopulmonary collapse. Histologic examination of the cervix is crucial for diagnosing this rare obstetric emergency.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Pathology
Background:
- Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric emergency with high mortality.
- Classical AFE presentation includes sudden dyspnea, hypotension, hypoxia, and cardiopulmonary arrest.
- Atypical presentations, such as isolated coagulopathy, are increasingly recognized.
Observation:
- A 27-year-old multigravida experienced continuous postpartum hemorrhage after an uncomplicated vaginal delivery.
- Disseminated intravascular coagulopathy (DIC) was diagnosed despite adequate uterine tone and massive blood product transfusion.
- Emergency laparotomy revealed a deep cervical laceration with amniotic fluid debris in the vasculature.
Findings:
- Histopathologic examination confirmed amniotic fluid embolism by identifying amniotic fluid debris within the cervical laceration's vasculature.
- The patient's hemorrhage was attributed to this atypical AFE presentation rather than the typical cardiopulmonary collapse.
- Hysterectomy was required to control the intractable vaginal bleeding.
Implications:
- This case highlights the importance of considering AFE in postpartum hemorrhage with coagulopathy.
- Thorough histologic examination of the cervix is critical for diagnosing atypical AFE presentations.
- Early recognition and diagnosis are vital for managing this life-threatening obstetric complication.