Dilemma Diagnosis Between Pulmonary Embolism and Amniotic Fluid Embolism During First Stage of Labor-A Case Report

Abstract

We report the sudden onset of dyspnea and loss of consciousness and fetal bradycardia in a middle-aged obese nulliparous woman at 39 weeks of gestation during first stage of labor leading to the decision for emergency cesarean section. Still during surgery, the mother underwent cardiac arrest. Transesophageal echocardiography during resuscitation showed right ventricular failure leading to the diagnosis of pulmonary embolism. Return of spontaneous circulation was achieved after emergency administration of thrombolysis with alteplase and cardiopulmonary resuscitation after 40 min. Severe bleeding, coagulopathy and persistent right ventricular failure resulted in persistent hemodynamic instability leading to supracervical hysterectomy and veno-arterial extracorporal life support. Both mother and baby survived without hypoxic brain injury.

Keywords: amniotic fluid embolism; cardiac arrest; emergency thrombolysis; pregnancy; pulmonary embolism; veno‐arterial.

FIGURE 1

(a) Normal cardiotocography (CTG) 2 h before the event; (b) CTG at the time of loss of consciousness with no detectable fetal heart beat. Parallel sonographic check for fetal heart action was negative, too (not shown).

FIGURE 2

Timeline of the case report. ECLS, extracorporal life support; ICU, intensive care unit; ROSC, return of spontaneous circulation.