Complete Recovery From Amniotic Fluid Embolism With Cardiac Point-of-Care Ultrasound (POCUS) and Rotational Thromboelastometry (ROTEM)-Guided Resuscitation During Cesarean Section: A Case Report

Amniotic fluid embolism (AFE) is a rare but severe obstetric emergency, with mortality approaching 50% within the first hour. The diagnosis of AFE is clinical and requires a high index of suspicion, along with the consideration of multiple differential diagnoses in peripartum patients presenting with sudden cardiovascular collapse. We report the case of a 38-week pregnant woman who, following cesarean section due to stationary labor, suffered a cardiac arrest during placental extraction. Following the return of spontaneous circulation, she exhibited bilateral decerebrate posturing and a severe coagulopathy consistent with disseminated intravascular coagulation (DIC). Cardiac point-of-care ultrasound (POCUS) revealed right heart chamber dilation, while rotational thromboelastometry (ROTEM) demonstrated profound hemostatic failure, guiding massive transfusion and hemodynamic support. Additional imaging ruled out pulmonary embolism and other differential diagnoses. This case report highlights the value of cardiac ultrasound and ROTEM for the prompt identification and guided resuscitative management of AFE. With multidisciplinary intensive care, the patient achieved complete neurological recovery and was discharged without deficits.