Presumed Amniotic Fluid Embolism Complicated by Disseminated Intravascular Coagulation and Refractory Postpartum...

Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric emergency characterized by sudden cardiorespiratory collapse, disseminated intravascular coagulation (DIC), and a high case-fatality rate. Because no confirmatory test exists, the diagnosis remains clinical and one of exclusion. We report a case of presumed AFE in a 39-year-old primigravida with uterine myomas, obesity, and chronic hypertension who underwent an elective primary cesarean delivery under spinal anesthesia. During manipulation of the placenta, the patient developed abrupt cardiovascular collapse requiring cardiopulmonary resuscitation, with return of spontaneous circulation followed by profound coagulopathy and refractory uterine atony. Management included goal-directed transfusion within a massive transfusion protocol, uterotonic therapy, a failed B-Lynch suture, supracervical hysterectomy, and a subsequent right oophorectomy for an ovarian-vein hemorrhage identified on imaging. Laboratory studies demonstrated an overt consumptive coagulopathy consistent with the International Society on Thrombosis and Haemostasis (ISTH) criteria, while a normal serum tryptase argued against an anaphylactic mechanism. The neonate was delivered in good condition (Apgar scores 9, 10, and 10 at 1, 5, and 10 min; umbilical-artery pH 7.38) and required no neonatal intensive care. The mother achieved full hemodynamic and neurological recovery. This case illustrates that survival from presumed AFE is achievable through early recognition, high-quality resuscitation, prompt correction of coagulopathy, and decisive surgical hemostasis, and it highlights the diagnostic reasoning required to distinguish AFE from its principal differential diagnoses.