Amniotic Fluid Embolism with Isolated Coagulopathy: A Report of Two Cases

Abstract

Case 1: The patient was a 29-year-old female with gravida 3, para 2, and abortus1 who had a spontaneous full term vaginal delivery. Her prenatal care was normal and intrapartum course was smooth with no use of pitocin. Spontaneous vaginal delivery with normal neonatal outcome occurred after membrane rupture. She developed profuse vaginal bleeding 1 hour and 10 minutes after delivery. The patient was transferred to our hospital one hour and 22 minutes after the bleeding episode. She presented with massive vaginal bleeding and physical examination revealed a soft uterus and uncoagulated blood in the vagina. Her blood pressure was 80/48 mmHg, with a pulse rate of 120/minute, respiratory rate 20/minute, and body temperature 37.7°C. No respiratory distress was noted. Coagulation studies revealed a fibrinogen of 26.1 mg/ dL, prothrombin time 32.9 seconds (8-12 seconds), Prothrombin International Normalised Ratio (INR) 3.57, partial thromboplastin time 41.7 seconds (23-35 seconds), Fibrinogen Degradation Product (FDP) 829.1 µg/mL (<5.0 µg/mL), D-Dimer 1162 µg/L (<324 µg/L), Hemoglobin (Hb) 7.6 g/dL, Hematocrit (Hct) 24.0%, and platelet count 101× THSD/µL. She was sent to the operative room for uterine curettage due to suspected retained placenta before the coagulation studies, but no abnormalities were found. Therefore, she received total abdominal hysterectomy because of persistent and uncoagulated bleeding. The vital signs and laboratory data became stable after hysterectomy and transfusion of 14 units of packed RBCs, 12 units of fresh frozen plasma, 17 units of cryoprecipitate, and 12 units of platelets.The pathological findings confirmed our diagnosis of AFE and revealed multifocal thrombi with fibrinoid and inflammatory exudates, presence of keratinizing desquamated squamous cells and amorphous materials, and a rare lanugos hair-like structure within the vascular lumen of the cervix and lower uterine segment [Table /Fig-1a1, a2].Case 2: The patient was a 35-year-old female with gravida 3, para 1, and abortus 1. She was at 39 weeks gestation and was otherwise healthy. She had taken no medication and had no known allergy. She was admitted for delivery. The labour course was uneventful without pitocin augumentation. Thin meconium staining was observed. The patient remained haemodynamically stable throughout the labour and delivered a healthy male baby.The obstetrician noted steady and profuse noncoagulated uterine Here, we present an uncommon variant involving isolated disseminated intravascular coagulation that developed without antecedent cardiopulmonary disturbances. Both patients developed symptoms soon after delivery. Blood test was sent at 14 minutes postpartum for the second patient due to suspected amniotic fluid embolism. Fetal components were observed in the uterine veins of the lower uterine segments in both cases. Amniotic fluid embolism with disseminated intravascular coagulopathy typically progresses faster than disseminated intravascular coagulopathy associated with other causes and symptoms. It usuall...

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