Abstract
Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric emergency with high maternal mortality. Diagnosis is mainly clinical because no specific diagnostic test is available. Acute pulmonary embolism (PE) is one of the most important differential diagnoses. A 30-year-old primigravida (PARA 0000) at 37 weeks of gestation was admitted for labor monitoring due to premature rupture of membranes. Despite initially stable maternal and fetal conditions, she suddenly developed acute respiratory failure, cyanosis, profound hypotension, loss of consciousness, and concomitant fetal distress. Aggressive resuscitation, endotracheal intubation, and emergency cesarean delivery were promptly performed. Intraoperatively, severe uterine atony with diffuse bleeding necessitated subtotal hysterectomy for hemorrhage control. Postoperatively, electrocardiography demonstrated an S1Q3T3 pattern with T-wave inversion in leads V1-V4, while echocardiography revealed mild pulmonary hypertension and severe tricuspid regurgitation, initially suggesting acute pulmonary embolism. However, after temporary hemodynamic stabilization, computed tomography pulmonary angiography and lower-extremity venous Doppler ultrasonography showed no evidence of thromboembolism. Laboratory investigations revealed profound hypofibrinogenemia, coagulopathy, and thrombocytopenia consistent with disseminated intravascular coagulation, favoring the diagnosis of amniotic fluid embolism. The patient received intensive supportive care, including blood transfusion, fresh frozen plasma replacement, and broad-spectrum antibiotics. She was successfully extubated after two days, the abdominal drain was removed on postoperative day five, and she was discharged in stable condition after nine days.
