Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 10 , ISSUE 3 ( July-September, 2018 ) > List of Articles


Successful Outcome of Amniotic Fluid Embolism Complicated with Severe Postpartum Hemorrhage and Neurological Deficit

Nik RB Affendi, San T Aung

Keywords : Amniotic fluid embolism (AFE), Coaguolopathy, Disseminated intravascular coagulation (DIVC), Intramyometrial prostaglandin, Obstetrics emergency, Postpartum hemorrhage.

Citation Information : Affendi NR, Aung ST. Successful Outcome of Amniotic Fluid Embolism Complicated with Severe Postpartum Hemorrhage and Neurological Deficit. J South Asian Feder Obs Gynae 2018; 10 (3):218-221.

DOI: 10.5005/jp-journals-10006-1593

Published Online: 01-08-2015

Copyright Statement:  Copyright © 2018; The Author(s).


An amniotic fluid embolism (AFE) 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 AFE during the caesarean section and complicated with severe postpartum hemorrhage, which was successfully aborted by intramyometrial prostaglandin F2 alpha injection, thus obviating the need for hysterectomy. Following 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.

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  1. Meyer J. Embolia pulmonar amnio caseosa. Bras med. 1926;2:301-303.
  2. Steiner PE, Lushbaugh CC. Maternal pulmonary embolism by amniotic fluid: as a cause of obstetric shock and unexpected deaths in obstetrics. Journal of the American Medical Association. 1941;117(15):1245-1254.
  3. Bowyer L. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer 2003–2005. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the UK. Obstetric Medicine: The Medicine of Pregnancy. 2008;1(1):54.
  4. Kulshrestha A, Mathur M. Amniotic fluid embolism: A diagnostic dilemma. Anesthesia, Essays and Researches. 2011;5(2):227.
  5. Resnik R, Swartz WH, Plumer MH, Benirschke K, Stratthaus ME. Amniotic fluid embolism with survival. Obstetrics and Gynecology. 1976;47(3):295-298.
  6. Abd Rahman R, Ismail NM, Yassin MA, Sulaiman AS. Comparative Review of Fourteen Years Maternal Mortality in Achieving MDG5 in Malaysia and Ukmmc. Malaysian Journal of Public Health Medicine 2013;13(1):59-63.
  7. Awad IT, Shorten GD. Amniotic fluid embolism and isolated coagulopathy: atypical presentation of amniotic fluid embolism. European journal of anaesthesiology. 2001;18(6):410- 413.
  8. Lee JH, Yang HJ, Kim J-H, Lee S-Y, Gill HJ, Kim B-K, et al. Amniotic fluid embolism that took place during an emergent Cesarean section-A case report. Korean journal of anesthesiology. 2010;59(Suppl):S158-S62.
  9. Bruce SL, Paul RH, Van Dorsten JP. Control of postpartum uterine atony by intramyometrial prostaglandin. Obstetrics and Gynecology. 1982;59(6):47S-50S.
  10. Jacobs MM, Arias F. Intramyometrial prostaglandin F2 alpha in the treatment of severe postpartum hemorrhage. Obstetrics and gynecology. 1980;55(5):665-666.
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