Amniotic fluid pulmonary embolism and COVID-19: Case report

Area of Science:

• Obstetrics and Gynecology
• Critical Care Medicine
• Infectious Diseases

Background:

• Amniotic fluid embolism (AFE) is a rare, life-threatening obstetric emergency characterized by the entry of fetal material into the maternal circulation.
• AFE typically presents with a triad of cardiovascular collapse, respiratory distress, and coagulopathy, though atypical forms exist.
• SARS-CoV-2 infection is known to induce a prothrombotic state and coagulopathy through mechanisms affecting Virchow's triad.

Observation:

• A 21-year-old pregnant woman presented with premature rupture of membranes, necessitating a cesarean section.
• During surgery, she experienced rapid hemodynamic deterioration, including bradycardia, hypotension, and desaturation, culminating in cardiorespiratory arrest.
• Post-event imaging confirmed amniotic fluid embolism with pulmonary edema, excluding other potential causes.

Findings:

• The patient's confirmed SARS-CoV-2 infection was identified as the sole potential cause for the amniotic fluid embolism.
• The clinical presentation and outcome suggest a strong association between COVID-19-induced immunological dysregulation and the development of AFE.
• This case underscores the complex interplay between viral infections and obstetric emergencies.

Implications:

• COVID-19 may represent a significant risk factor for developing amniotic fluid embolism in pregnant patients.
• Understanding the immunological mechanisms linking SARS-CoV-2 to AFE is crucial for risk stratification and management.
• This case highlights the need for vigilance regarding potential AFE in pregnant patients with active or recent COVID-19 infection.