Amniotic Fluid Embolism in Donor Egg Twin Pregnancy: A Clinical Challenge in Critical Care

Amniotic fluid embolism (AFE) is a rare but life-threatening obstetric emergency marked by respiratory distress, severe hypotension, and coagulopathy with haemorrhage. This case involves a 45-year-old nulliparous woman with a dichorionic diamniotic twin pregnancy via in vitro fertilisation (IVF) with a donor egg. At 36 weeks' gestation, the patient developed sudden respiratory distress following the detection of persistent maternal tachycardia. Cardiotocography (CTG) revealed foetal distress, necessitating an emergency caesarean section, which resulted in the delivery of two live neonates. Her postpartum course was complicated by haemorrhage managed with a vaginal balloon and a second episode of respiratory distress with hypoxia. Admitted to the intensive care unit (ICU) for supportive care, she recovered well. Further investigations excluded pulmonary embolism and infection. Whilst peripartum cardiomyopathy (PPCM) was considered, the presence of massive haemorrhage and disseminated intravascular coagulation (DIC) strongly suggested AFE. This case highlights AFE's rare occurrence in an IVF pregnancy and supports the emerging hypothesis that conception through donor eggs may pose a significant, under-recognised immunologic risk for AFE.