A case of postpartum cardiopulmonary arrest involving amniotic fluid embolism

Abstract

A A 33-year-old primipara was transferred to our hospital after suffering massive uterine hemorrhage and shock one hour after normal delivery. Seven minutes after arrival, she displayed pulseless electrical activity (PEA), but was successfully resuscitated following nine-minute cardiopulmonary resuscitation (CPR). Transcatheter arterial embolization (TAE) was performed and she was admitted to intensive care unit (ICU). Following admission to ICU, the patient was diagnosed with disseminated intravascular coagulation (DIC) caused by amniotic fluid embolism. In addition to DIC treatment, she received methylprednisolone therapy for three days and underwent a two-day plasma exchange. On the 19th day of treatment, she developed cerebral venous sinus thrombosis and we started anticoagu-lant therapy. On the 23rd day of treatment, the patient again had uterine hemorrhage and underwent hysterectomy on the same day. She was pathologically diagnosed with Type 1 retained placenta (trapped placenta) and amniotic fluid embolism. The patient was discharged on the 134th day of treatment with a modified Rankin Scale of 1. Because amniotic fluid embolism is rare and has a poor prognosis, diagnosis and treatment of the disease require that differ-ent medical departments make quick judgments and have a cooperative system for intensive care in place. (JJAAM. 2014; 25: 57-62)