Amniotic Fluid Embolism Complicated by Severe Coagulopathy and Ischemic Stroke: A Case Report

Abstract

Background. Amniotic fluid embolism is a rare but severe obstetric complication associated with high maternal and fetal mortality and morbidity, classically combining acute cardiorespiratory distress, impaired consciousness, and severe consumptive coagulopathy. Case presentation. A 42-year-old woman at 39 weeks and 2 days of gestation presented during labor with a generalized tonic-clonic seizure immediately following spontaneous rupture of membranes, followed by persistent impaired consciousness and severe hypoxemic respiratory distress (SpO2 40%). After airway management, an emergency cesarean section was performed. Despite a normal initial coagulation profile, severe disseminated intravascular coagulation developed rapidly after fetal extraction, with a markedly low fibrinogen level (0.5 g/L), requiring massive transfusion and hemostatic hysterectomy. Surgical re-exploration was required on postoperative day 1 for secondary hemoperitoneum, despite biological improvement of the coagulopathy. The subsequent course was marked by multifocal ischemic brain lesions (bilateral cerebellar and frontal) of embolic appearance, resulting in right hemiparesis with favorable recovery. Conclusion: This case illustrates the heterogeneous and dynamic presentation of amniotic fluid embolism, highlights the value of fibrinogen as an early biological marker despite logistical constraints limiting its timely measurement, underscores the role of hemostatic hysterectomy in the management of refractory obstetric hemorrhage, and emphasizes the need for systematic neurological monitoring following hypoxic seizure episodes to enable early detection of ischemic cerebrovascular complications.