An Unusual Presentation of an Amniotic Fluid Embolism: Fetal Bradycardia As the First Sign

TL;DR

A rare case of amniotic fluid embolism is presented where fetal bradycardia occurred before maternal symptoms, highlighting the need for vigilance in recognizing atypical signs.

Contribution

This case study highlights fetal bradycardia as an unusual and early sign of amniotic fluid embolism, expanding clinical awareness of its atypical presentations.

Findings

Fetal bradycardia preceded maternal symptoms in a case of amniotic fluid embolism.

The patient experienced severe maternal complications including seizure, cardiac arrest, and disseminated intravascular coagulopathy.

Aggressive management led to hemodynamic stability and recovery.

Abstract

Amniotic fluid embolism (AFE) is a potentially fatal maternal condition demanding awareness from obstetricians and anesthesiologists regarding its different manifestations. The typical presentation involves maternal respiratory distress, cardiovascular collapse, neurological changes, and coagulopathy followed by fetal distress.

This unusual case study emphasizes that fetal compromise may precede maternal decompensation as the initial sign of AFE. Fetal distress is a known symptom of AFE and is typically seen due to cardiorespiratory issues that lead to reduced uteroplacental perfusion, resulting in fetal hypoxia. In the case presented, fetal bradycardia occurred before any visible maternal symptoms, suggesting that fetal distress could be induced by factors independent of the mother's cardiopulmonary status.

A 34-year-old healthy G4P2012 at 41 weeks and 2 days gestation who was initially laboring on the floor was emergently taken to the operating room for a cesarean delivery due to fetal bradycardia. Around the time the fetus was delivered, the patient displayed seizure activity, followed by a complete loss of consciousness and cardiac arrest. The patient was intubated and underwent cardiopulmonary resuscitation and defibrillation, subsequently converting to a wide complex tachycardia. In the operating room, there was evidence of heavy vaginal bleeding, uterine atony, and a fulminant form of disseminated intravascular coagulopathy (DIC), which required aggressive management over the next four hours. After achieving hemodynamic stability, the patient was transferred to the surgical intensive care unit (SICU), extubated on day 3, and discharged home on day 8.

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