Amniotic fluid embolism and spontaneous hepatic rupture during uncomplicated pregnancy: a case report and literature review

J Matern Fetal Neonatal Med. 2020 May;33(10):1759-1766. doi: 10.1080/14767058.2018.1526915. Epub 2018 Nov 4.

Abstract

Amniotic fluid embolism (AFE) and spontaneous hepatic rupture both are extremely rare complications of pregnancy that can be fatal to mother and/or child. AFE is characterized by a sudden collapse of the cardiovascular system, a change in mental status, and disseminated intravascular coagulation (DIC), occurring immediately during labor, delivery, or postpartum, caused by the inflow of amniotic components into the maternal circulation. Spontaneous hepatic rupture during pregnancy which is most often occurs alongside hypertensive disorders, eclampsia, or HELLP syndrome. We report on the case of a 28-year-old woman (G3P2) who is suffering from AFE and spontaneous hepatic rupture, without history of hypertensive disorders, preeclampsia/eclampsia, or HELLP syndrome, and she died suddenly after delivering of a severe asphyxial neonate within 1 h with postpartum of hepatic rupture and massive hemorrhage. The lack of typical clinical signs and symptoms resulted to the difficulty of early diagnosis. If AFE and hepatic rupture is highly suspected in a pregnant patient, a collaborative multidisciplinary approach is mandatory. Pregnancy women is simultaneously complicated in amniotic fluid embolism and spontaneous hepatic rupture, similar cases are infrequent in the literature, which is reviewed in this report, explore the pathophysiological changes, we hope that can be helpful for the prevention, diagnosis and treatment of similar cases.

Keywords: Amniotic fluid embolism; DIC; spontaneous hepatic rupture; thrombophilia.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Eclampsia
  • Embolism, Amniotic Fluid / diagnosis
  • Embolism, Amniotic Fluid / physiopathology*
  • Fatal Outcome
  • Female
  • HELLP Syndrome
  • Heart Arrest / etiology
  • Heart Arrest / therapy
  • Humans
  • Liver Diseases / diagnosis
  • Liver Diseases / pathology*
  • Pregnancy
  • Risk Factors
  • Rupture, Spontaneous / diagnosis
  • Rupture, Spontaneous / pathology*