Amniotic Fluid Embolism Complicated with Hepatic Rupture: A Case Report

Yanhong Xu,1– 4,* Yulong Zhang,1– 4,* Jiaying Zheng,1– 4 ChunXia Chen,1,5 Xia Xu,1– 4 Jianying Yan1– 4 1College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Maternity and Child Health Hospital Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 2Fujian Clinical Research Center for Maternal-Fetal Medicine, Fuzhou, Fujian, People’s Republic of China; 3Laboratory of Maternal-Fetal Medicine, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China; 4National Key Obstetric Clinical Specialty Construction Institution, Fuzhou, Fujian, People’s Republic of China; 5Imaging Department for Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianying Yan, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University Fujian Maternity and Child Health Hospital, No. 18 Daoshan Road, Gulou District, Fuzhou, Fujian, People’s Republic of China, Email [email protected]: Amniotic fluid embolism (AFE) is a rare but highly fatal complication during delivery. It occurs when amniotic fluid suddenly enters the maternal circulation, causing acute multi-organ failure. Prompt recognition and management are crucial for improving survival rates.Case Presentation: We reported a 37-year-old woman at 39 weeks gestation who developed AFE during labor induction. The patient presented with sudden cyanosis, dyspnea, and restlessness, followed by cardiac arrest during emergency cesarean section. Postoperative refractory postpartum hemorrhage (RPPH) necessitated multiple interventions, including hysterectomy and vascular embolization. Subsequent laparotomy revealed a subcapsular hematoma with linear tear in the left hepatic lobe, which was successfully repaired. The patient required massive transfusion and intensive care but eventually stabilized.Conclusion: This case involved a life-threatening AFE complicated by cardiac arrest, RPPH, and traumatic liver rupture. The patient was successfully treated through multidisciplinary collaboration. It highlights three key aspects of critical maternal care: rapid recognition, damage control, and systemic resuscitation.Keywords: amniotic fluid embolism, hepatic rupture, disseminated intravascular coagulation, post-partum hemorrhage, subcapsular hematoma