Successful outcome of amniotic fluid embolism complicated with severe postpartum hemorrhage and neurological deficit

Abstract

An amniotic fluid embolism (AE) is one of the rare obstetric emergency with a high maternal mortality rate. This condition is clinically characterized by three distinct phases: during the first phase, sudden onset of respiratory distress and cyanosis occur within seconds followed by hypotension, shock, and loss of consciousness within minutes. Of those who survive the initial insult, 40 to 50% enter the second phase characterized by coagulopathy and hemorrhage within hours. During the third phase, acute symptoms are over, and tissue injury of the brain, lung or renal is for the most part already established. The patient may succumb due to multisystem organ failure or infection acquired in the hospital. We report an interesting case of a middle-aged pregnant mother who developed AE during the caesarean section and complicated with severe postpartum hemorrhage, which was successfully aborted by intramyometrial prostaglandin 2 alpha injection, thus obviating the need for hysterectomy. ollowing that she also suffered from expressive dysphasia and have an uneventful recovery through the speech therapy. We concluded that early diagnosis and timely intervention that may be the best way to achieve the favorable outcome of amniotic fluid embolism and intramyometrial prostaglandin is the available simple drug for preventing a peripartum hysterectomy during amniotic fluid embolism.