Unresponsive primipara after rupture of membranes

Abstract

Amniotic fluid embolism, also called anaphylactoid syndrome of pregnancy, is a rare but severe problem in obstetrics. It occurs in 8/100,000 births and the maternal mortality is up to 90%. We report the case of a patient with amniotic fluid embolism who was transferred to our hospital. The initial presentation was an unresponsive patient after spontaneous rupture of the membranes. The massive hypotension and coagulopathy as well as fetal bradycardia of 60 bpm led, after stabilisation of the mother, to an emergency caesarean section. The neonate expired hours later, despite neonatological intensive care. During the operation, we had to deal with massive bleeding due to the coagulopathy. Through interdisciplinary teamwork including Bakri postpartum balloon insertion through the obstetrics team, uterine artery embolism by the interventional radiologists and transfusion of blood products, the maternal life was saved and the patient was discharged 9 days after admission.

A Case of Consumptive Coagulopathy Before Cardiopulmonary Failure in Amniotic Fluid Embolism and Review of Literature: A Perspective of the Latent Onset and Progression of Coagulopathy

“…We performed a literature search for English articles that described cases and original investigations involving AFE that were diagnosed with the criteria proposed by Clark [6] and reviews/guidelines of AFE that included a clear statement of a chronological relationship between cardiopulmonary symptoms and evaluation of coagulopathy in PubMed up to March 2023 using the search terms "amniotic fluid embolism" and "coagulopathy." We retrieved 19 case reports/series [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], five original articles [5,[29][30][31][32], and 11 reviews/guidelines [33][34][35][36][37][38][39][40][41][42][43] (Table 5). The original articles and case reports/studies reported that AFEassociated coagulopathy was evaluated and detected after cardiopulmonary symptoms, which was supported by the reviews reporting that it developed after cardiorespiratory insufficiency.…”