Abstract
Amniotic fluid embolism is one of the most severe complications in the perinatal period. We report a case of a 35-year-old woman who was suspected of having an amniotic fluid embolism. After a cesarean section for placental abruption, vaginal bleeding occurred, and the patient's circulatory and respiratory conditions deteriorated. She was transferred to our hospital and underwent an emergency laparotomy to achieve hemostasis. On admission to the ICU, she suffered from severe respiratory failure, cardiac dysfunction, and renal failure. Her P/F ratio was as low as 67 mmHg, so we performed mechanical ventilation. Because findings of transesophageal echo and pulmonary artery catheter suggested severe congestion, we adjusted the preload with phlebotomy and continuous hemofiltration. Extubation of the tracheal tube was performed on postoperative day 4, and the patient was discharged from the hospital on postoperative day 48. A definitive diagnosis was possible because serum zinc coproporphyrin levels were high on admission to the ICU. When abnormal bleeding, respiratory distress and circulatory dysfunction are seen to occur in patients in the perinatal period, it is important to bear the possibility of an amniotic fluid embolism in mind, and to proceed with appropriate intensive care intervention.
