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

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Critical Care Medicine

Background:

• Amniotic fluid embolism (AFE) is a rare, life-threatening obstetric emergency.
• Limited data exists on AFE during the second trimester or abortion procedures.
• Management guidelines for AFE in these specific settings are scarce.

Purpose of the Study:

• To report a case of amniotic fluid embolism (AFE) occurring during a second-trimester induced abortion.
• To highlight the diagnostic challenges and management of AFE in this underreported context.

Main Methods:

• Case presentation of a 32-year-old woman undergoing induced abortion at 24 weeks' gestation.
• Clinical management included resuscitation, completion of the procedure, and uterine artery embolization for hemorrhage.
• Diagnosis of AFE was based on cardiovascular collapse and disseminated intravascular coagulation (DIC) disproportionate to blood loss.

Main Results:

• The patient experienced hypoxia and pulseless electrical activity during dilation and evacuation.
• Return of spontaneous circulation (ROSC) was achieved following resuscitation.
• The patient recovered with transient short-term memory loss, with AFE diagnosed as the primary complication.

Conclusions:

• AFE should be considered in cases of acute collapse during pregnancies over 20 weeks gestation, particularly during abortion procedures.
• Abortion restrictions may lead to delayed care, potentially increasing gestational age and the incidence of AFE.
• Further research is needed on the impact of abortion restrictions on maternal mortality and morbidity, with AFE and thromboembolism as key considerations.