Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 28;2023(1):13.
doi: 10.5339/qmj.2023.13. eCollection 2023.

Amniotic fluid embolism causing multiorgan embolisms and reinforces the need for point-of-care ultrasound

Nissar Shaikh  1 , Muhammad Fras Alhammad  1 , Seema Nahid  1 , Amara Umm E  2 , Ifrah Fatima  3 , Firdous Ummunnisa  4 , Slawa Abu Yaqoub  5
Affiliations

Amniotic fluid embolism causing multiorgan embolisms and reinforces the need for point-of-care ultrasound

Nissar Shaikh et al. Qatar Med J. .

Abstract

Introduction: Pregnant patients are at risk of several possible complications during the peripartum period. Amniotic fluid embolism (AFE) is a peripartum complication with high mortality and morbidity. The sudden entry of amniotic fluid into the maternal circulation causes a rapid and dramatic sequence of clinical events called AFE. The reported incidence of AFE after a cesarean section is around 19%, and after a normal delivery, it is 11%. AFE causing multiple embolisms is not reported in the literature, nor is the use of point-of-care ultrasound (POCUS) in the diagnosis of AFE. We report a case of AFE causing pulmonary and ovarian embolisms.

Case: A 34-year-old pregnant lady had an elective lower section cesarean section (LSCS) for transverse lying and placenta previa under combined spinal and epidural anesthesia. She was gravida 3 para 2 and had regular antenatal check-ups, and she presented for her LSCS at 36 weeks of gestation. Immediately after delivery of the fetus, the patient had convulsions, cardiac arrest, and disseminated intravascular coagulopathy (DIC). Immediately, cardiopulmonary resuscitation started, and the team achieved a return of spontaneous circulation (ROSC) in 3 minutes. DIC was corrected with blood and blood products during this maneuver, and POCUS of the inferior vena cava and heart showed multiple small particles floating, thus confirming the diagnosis of AFE in this patient. The patient was transferred to the intensive care unit (ICU), intubated, and ventilated, necessitating a vasopressor infusion. Computed tomographic pulmonary angiography (CTPA) showed pulmonary embolism and ovarian vein embolism, which were managed with heparin infusion. She was hemodynamically stable and weaned from vasopressors, and the ventilator was then extubated on day 13 of ICU admission. She remained awake and in stable condition. The patient was transferred to the ward and subsequently discharged to go home on the 20th-day post-delivery.

Conclusion: AFE can be quickly diagnosed using clinical manifestations and POCUS, and it can be managed early for better patient outcomes. POCUS will show multiple smaller and a few larger amniotic fluid emboli in the heart and vena cava. These larger AFE emboli can migrate and cause multiple embolisms, requiring systemic anticoagulation.

Keywords: Amniotic fluid embolism; POCUS; cardiac arrest; disseminated intravascular coagulopathy; emergency; multiorgan dysfunction; multiple embolisms; peripartum; prevention.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they do not have any conflict of interest either academic or financial.

Figures

Figure 1.
Figure 1.
POCUS showing amniotic fluid particles in the IVC.
Figure 2.
Figure 2.
POCUS showing larger particles in the IVC.
Figure 3.
Figure 3.
POCUS showing multiple particles on the right side of the heart.
Figure 4.
Figure 4.
Patient’s chest X-ray showing pulmonary congestion post-cardiac arrest.
Figure 5.
Figure 5.
CT chest showing pulmonary embolism.
Figure 6.
Figure 6.
CT abdomen showing bilateral ovarian vein thrombosis.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

  • Post-mortem diagnosis of amniotic fluid embolism.
    Gentilomo A, Tambuzzi S, Gentile G, Boracchi M, Andreola S, Zoia R. Gentilomo A, et al. Autops Case Rep. 2024 Feb 2;14:e2024472. doi: 10.4322/acr.2024.472. eCollection 2024. Autops Case Rep. 2024. PMID: 38476730 Free PMC article. No abstract available.

References

    1. Knight M, Berg C, Brocklehurst P, Kramer M, Lewis G, Oats J et al. Amniotic fluid embolism incidence, risk factors, and outcomes: a review and recommendations. BMC Pregnancy Childbirth. 2012;;12::7. - PMC - PubMed
    1. Clark SL, Hankins GD, Dudley DA, Dildy GA, Porter TF. Amniotic fluid embolism: analysis of the national registry. Am J Obstet Gynecol. 1995 Apr;172((4 Pt 1):):1158–67. - PubMed
    1. Sultan P, Seligman K, Carvalho B. Amniotic fluid embolism: update and review. Curr Opin Anaesthesiol. 2016;;29((3):):288–96. - PubMed
    1. Piva I, Scutiero G, Greco P. Amniotic fluid embolism: an update on the evidence. Med Toxicol Clin Forens Med. 2016;;2::1.
    1. Evans S, Brown B, Mathieson M, Tay S. Survival after an amniotic fluid embolism followed the use of sodium bicarbonate. BMJ Case Rep. 2014;;30::1–3. - PMC - PubMed

LinkOut - more resources