Abstract
The case is a 32 year old woman with twin pregnancy. The first child was delivered by absorptive delivery. However, because of sudden and significant fetus bradycardia at the time of the second child's delivery, an urgent cesarean operation was performed. We delivered the second child under general anesthesia with rapid sequence induction. The operation was completed without bleeding tendency or significant pulmonary-ciruculatory failure. After she breathed spontaneously, she showed no responses to verbal commands. In response to her delayed awaking, we performed an artery blood gas analysis and blood examination and found significant metabolic acidosis, decreased platelet count and coagulation disorder. She entered the intensive care unit with suspected disseminated intravascular coagulation syndrome by amniotic fluid embolism. Later, we were led to a diagnosis of clinical amniotic fluid embolism. It was difficult to doubt amniotic fluid embolism until we performed a blood examination. The onset style of amniotic fluid embolism varies, and it is always necessary to take it into consideration as a differential diagnosis in obstetric anesthesia.
