Atypical amniotic fluid embolism presenting with isolated coagulopathy: a case report

Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric complication characterised by the sudden entry of amniotic fluid or fetal components into the maternal circulation, triggering severe cardiorespiratory collapse, coagulopathy, or both. While most patients exhibit abrupt hypotension and hypoxia, a coagulopathy-dominant subtype has increasingly been recognised but remains easily overlooked. Its insidious onset and absence of overt cardiopulmonary signs often delay recognition and appropriate intervention. We report a 30-year-old Chinese woman (gravida 2, para 1) who developed severe coagulopathy-dominant AFE shortly after the vaginal delivery of a term singleton infant at a tertiary comprehensive hospital. She presented exclusively with massive postpartum bleeding and precipitous drops in fibrinogen (3.21→ 0.37 g/L within 15 min) and platelets (96→46 × 10⁹/L), without hypoxia or cardiopulmonary compromise. Recognising the disproportionate coagulopathy, clinicians rapidly initiated a protocol involving massive transfusion emphasising early fibrinogen supplementation, followed by timely surgical intervention. Despite profound disseminated intravascular coagulation and recurrent haemorrhage, coordinated multidisciplinary management resulted in complete recovery without sequelae. This case highlights an atypical, coagulopathy-dominant case of AFE in which rapid recognition of isolated coagulopathy and early fibrinogen-guided transfusion likely avoided a fatal outcome. Vigilant monitoring and prompt, team-based intervention are essential to improving survival in such non-classical AFE presentations.