Amniotic fluid embolism and uterine atony-two case reports and a literature review

Amniotic fluid embolism (AFE) is a life-threatening condition characterized by the entry of amniotic fluid into the maternal circulation and triggering a cytokine storm. The incidence of AFE varies across different populations and studies, ranging from 1.9 to 6.1 cases per 100,000 deliveries. It can be classified into two clinical types: the cardiopulmonary collapse type (or classic type) and the disseminated intravascular coagulopathy (DIC) type involving atonic bleeding and rapid deterioration of coagulopathy. Here we present the cases of two multiparous women who experienced DIC-type AFE during labor, resulting in uterine atony and emergency peripartum hysterectomy.

We present two cases: the first of a 38-year-old multiparous pregnant woman at 39 weeks' gestation who was admitted for induction of labor due to a placental disorder, and the second of a 39-year-old multiparous woman at 38 weeks' gestation who was admitted for induction of labor due to intrauterine fetal death. In both cases, after vaginal delivery and delivery of the placenta, the puerpera developed uterine atony, postpartum hemorrhage, and hypovolemic shock, with laboratory findings demonstrating disseminated intravascular coagulopathy. Conservative treatment with parenteral fluid resuscitation, transfusion of blood units, fresh frozen plasma, platelets, fibrinogen, and uterotonics showed no significant effect and emergency peripartum hysterectomy was performed. Pathohistological examination of the uterus revealed thrombosis of the vascular spaces and amniotic fluid embolism. Both patients were discharged from hospital and proper recovery was confirmed at follow-up examinations.

Amniotic fluid embolism is a rare and potentially fatal condition. Prompt resuscitative efforts and emergency treatment are crucial for improving maternal and neonatal outcomes.