Amniotic Fluid Embolism with Postoperative Collapse and Coagulopathy: Clinicopathologic Correlation in a Case with...

Amniotic fluid embolism (AFE) is a rare peripartum emergency characterized by abrupt cardiopulmonary compromise and consumptive coagulopathy. We report a peripartum case in which hemodynamic collapse and massive vaginal hemorrhage occurred shortly after a repeat low transverse cesarean section performed for non-reassuring fetal heart tracing during a trial of labor. Intraoperatively, a small, stable left broad ligament hematoma was noted but remained unchanged on re exploration. Rapid deterioration prompted emergent hysterectomy for profound uterine atony and hemorrhage. Histopathologic examination of the hysterectomy specimen demonstrated fetal squamous elements admixed with fibrin within maternal uterine vessels, supported by pancytokeratin and CD31 immunohistochemistry. The placenta showed high-grade fetal vascular malperfusion with a hypercoiled cord and multifocal thrombi, correlating with the intrapartum fetal status but independent of AFE pathogenesis. This case highlights the diagnostic challenge of recognizing AFE when a plausible surgical bleeding source is present and emphasizes the importance of clinicopathologic correlation.