Amniotic fluid embolism in late second trimester abortion: a case report

Amniotic fluid embolism (AFE) is a rare and catastrophic complication of pregnancy characterised by hypoxia, cardiovascular collapse, and disseminated intravascular coagulation (DIC). Scant literature exists on the prevalence of second trimester AFE or AFE at the time of abortion. Management recommendations specific to these settings are lacking. We present a case of AFE at the time of second trimester abortion.

A 32-year-old woman, gravida 4, para 3, presented for induced abortion at 24 weeks and 2 days. Her history was significant for three prior caesarean sections and sleeve gastrectomy. During the dilation and evacuation, the patient developed persistent hypoxia and pulseless electrical activity. The procedure was completed during resuscitation and return of spontaneous circulation (ROSC) was achieved. The patient underwent uterine artery embolisation for persistent uterine bleeding without signs of active extravasation in the setting of DIC. She experienced transient short-term memory loss but was otherwise neurologically intact. AFE was diagnosed based on cardiovascular collapse and DIC out of proportion to haemorrhage.

AFE is sparsely described in abortion care. Clinicians must maintain a broad differential and consider AFE at the time of acute collapse in pregnancies greater than 20 weeks gestation. This is especially crucial as abortion bans may increase the incidence of AFE as delayed abortion care may yield an increase in gestational age and maternal morbidity. AFE and thromboembolism are the most likely diagnoses consistent with our case. Future investigation is needed to explore the long-term effects of abortion restrictions on maternal mortality and morbidity.