A Case Report of Amniotic Fluid Embolism with Disseminated Intravascular Coagulation and Massive Hemorrhage

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric emergency characterized by sudden cardiovascular collapse, hypoxia, and coagulopathy, often progressing to disseminated intravascular coagulation (DIC) and multi-organ failure. The estimated incidence is .8 - 1.8 per 100k deliveries. Despite its rarity, AFE is a leading cause of maternal mortality in high-income nations with fatality rates from 20-60%. This high mortality rate is a result of the pathophysiological cascade AFE triggers. Fetal antigens enter the maternal circulation leading to acute pulmonary hypertension, right and left ventricular failure, hypoxemia, cardiopulmonary arrest, and DIC. We describe the management of a patient who presented with AFE and the hallmark features of this rare complication.

A 38-year-old female presented for induction of labor at 38 weeks' gestation. An uncomplicated epidural was placed at 2cm dilation. She progressed to full cervical dilation, began pushing, and became progressively lightheaded followed by fetal heart rate deceleration. The patient became unresponsive and pulseless. Advanced Cardiac Life Support (ACLS) was initiated while simultaneous vacuum-assisted vaginal delivery was performed. ACLS guidelines regarding pulseless electrical activity (PEA) / arrest were followed for one complete round before return of spontaneous circulation (ROSC). The patient was emergently intubated via rapid sequence induction due to airway protection and pending cardiopulmonary compromise. Massive obstetric hemorrhage ensued, prompting placement of a Bakri balloon and administration of multiple uterotonics and tranexamic acid. Norepinephrine, epinephrine, and vasopressin infusions were initiated while invasive access was obtained.

AFEs are rare, life-threatening events that rapidly progress to cardiac arrest, DIC, and death. Early recognition, prompt establishment of invasive monitoring, rapid escalation of vasoactive support, and early initiation of massive transfusion are critical to improving survival. Equally important is early activation of a multidisciplinary response, including anesthesiology, maternal-fetal medicine, critical care, transfusion medicine, and trauma-based surgical teams to coordinate resuscitation and hemorrhage control.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2041

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