[Successful anesthetic management of a postpartum patient with amniotic fluid embolism]

We report a case of amniotic fluid embolism (AFE) after cesarean section (C/S). A 35-year-old primigravida with placenta previa and myoma underwent C/S because of nonreassuring fetal status caused by medical induction of labor. C/S was performed smoothly under general anesthesia and the baby had no problems. Immediately after the end of C/S, she went into sudden cardiovascular collapse and massive postpartum hemorrhage (PPH) became apparent. The mechanical ventilation with 100% oxygen was continued. Cardiovascular stabilization was attained with immediate administration of noradrenaline and blood transfusion. As her clinical course indicated coagulopathy due to disseminated intravascular coagulation (DIC), we gave transfusion of fresh frozen plasma and red cell concentrate before the diagnosis of DIC was established by laboratory tests. Since we thought that manual pressure and uterotonics were not adequate to stop PPH, we performed uterine artery embolization additionally. The PPH with DIC was stopped by these measures seven hours after C/S. The patient and her baby left the hospital with no complications. AFE is a rare and often fatal obstetric condition, characterized by sudden cardiovascular collapse, and massive bleeding with DIC. The prompt awareness and initiation of appropriate measures are mandatory for patient's survival.