Amniotic Fluid Embolism After Cervical Ripening

Amniotic fluid embolism (AFE) is a rare condition that can have catastrophic maternal and infant consequences. It can lead to rapid multisystem failure and is responsible for a significant portion of maternal deaths. The diagnosis is frequently made late in the pathological process, and the treatment is mainly supportive and infant delivery. It cannot be prevented. Whether cervical ripening and labor induction are risk factors is controversial. A 31-year-old woman who was undergoing cervical ripening and induction of labor at 38 weeks gestation for medication-controlled gestational diabetes (A2GDM) was admitted for delivery. She received five doses of 25 µg vaginal misoprostol serially and, ultimately, a Foley catheter cervical balloon. After approximately 24 hours, she had the sudden onset of unexpected persistent fetal bradycardia. Her cervix was 4 cm at the time of the fetal distress. When she arrived in the operating room, she was hypoxic and difficult to awaken. An emergency cesarean delivery was performed under general endotracheal anesthesia. Immediately after the delivery of a profoundly depressed and acidotic infant with an umbilical cord pH of 6.84, she became hypotensive, requiring vasopressors. After diffuse intravascular coagulation was diagnosed, treatment for AFE was implemented. AFE has a high mortality rate, and the length of time needed to identify the condition and the availability of specialty resources are two elements that can affect the outcome. Newer alternative treatments, such as the supportive "A-OK" (atropine, ondansetron, and ketorolac administration) protocol for AFE, are discussed. Ultimately, both mother and baby survived and, at the six-month check, are doing well with no sequelae.