Amniotic fluid embolism with isolated coagulopathy: a case report.
BACKGROUND
Amniotic fluid embolism is a life-threatening complication of pregnancy accompanied by a high mortality rate. The common clinical presentation is sudden onset of dyspnea, hypotension inappropriate to the volume of blood loss, and hypoxia, followed by cardiopulmonary arrest. Recently, cases of amniotic fluid embolism with isolated coagulopathy as an atypical presentation have been reported.


METHODS
A 27-year-old multigravida presented with continuous postpartum oozing after an uneventful vaginal delivery at 38 weeks of gestation. Laboratory evidence revealed disseminated intravascular coagulopathy. Despite good uterine contractions and massive blood component therapy, vaginal bleeding continued and finally led to emergency laparotomy. Histopathologic examination showed a deep cervical laceration in the endocervix, and multiple areas of amniotic fluid debris were demonstrated in the laceration site vasculature of the endocervix. After hysterectomy, the patient recovered fully, without sequelae.


CONCLUSIONS
This case represents atypical symptoms and signs: clinical hemorrhage in the initial presentation rather than the classical pattern of cardiopulmonary collapse. In cases of suspected amniotic fluid embolism with an atypical presentation, a thorough histologic examination of the uterus, including the cervix, is critical to making the diagnosis of amniotic fluid embolism.
Department of Obstetrics and Gynecology, Ajou University School of Medicine, San-5, Wonchon-dong, Paldal-ku, Kyunggi-do, 443-749 Suwon, South Korea. yangji@madang.ajou.ac.kr
Jeong-In
JI
Yang
Haeng-Soo
HS
Kim
Ki-Hong
KH
Chang
Hee-Sug
HS
Ryu
Hee-Jae
HJ
Joo
D000328:Adult; D002584:Cervix Uteri; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D004619:Embolism, Amniotic Fluid / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D006473:Postpartum Hemorrhage / Q000209:etiology*; D011247:Pregnancy