Amniotic Fluid Embolism in a Patient Presenting for Induction of Labor for Cholestasis of Pregnancy.

ABSTRACT

Amniotic fluid embolism (AFE) is a rare but potentially catastrophic complication during pregnancy. The most common presenting symptoms of AFE are cardiac arrest, hemodynamic instability, and profound hemorrhage. Here, we present a case of a 28-year-old female with a past medical history of anemia, gestational diabetes, hypothyroidism, anxiety, and depression, presenting for induction of labor for cholestasis of pregnancy. The labor course was complicated by sudden cardiac arrest and resuscitation, followed by an emergent bedside peri-cardiac arrest cesarean section. Subsequently, the patient developed coagulopathy, uterine atony, and bleeding from the vagina and cervix. The AFE protocol was initiated, and the care team proceeded with a hysterectomy. Supportive treatment correcting for metabolic acid-base disturbances and coagulopathies was maintained. The patient was stabilized for air transport to a higher level of care.