Amniotic fluid embolism complicated by pulmonary embolism leading to multiple organ dysfunction: case report

Rationale: Amniotic fluid embolism (AFE) is a rare and life-threatening obstetric emergency with an extremely high mortality rate. Pulmonary thromboembolism (PTE), a severe comorbidity of AFE in the puerperium, further exacerbates hemodynamic disturbance and multiple organ injury, posing great challenges to clinical diagnosis and targeted intervention. Relevant clinical diagnosis and treatment experience still need to be further supplemented and optimized. Patient concerns: A 37-year-old advanced-age parturient with a history of hysteroscopic adhesiolysis suffered a sudden onset of AFE following forceps-assisted delivery, complicated with PE and severe multiple organ dysfunction. The patient developed acute respiratory failure, cardiogenic shock, and coagulopathy in a short period with critical clinical manifestations, requiring emergent intensive care intervention. Diagnosis: Amniotic fluid embolism complicated with pulmonary embolism and multiple organ dysfunction syndrome (MODS). Interventions: A multidisciplinary team (MDT) formulated and implemented a comprehensive and individualized treatment regimen for the patient: invasive mechanical ventilation was administered for respiratory support; precise volume management guided by pulse indicator continuous cardiac output (PICCO) was adopted, combined with vasoactive agents and inotropic drugs for circulatory support; tranexamic acid (TXA) and component blood transfusion were given to correct coagulopathy, and risk-stratified anticoagulant therapy was promptly initiated after the recovery of coagulation function; standardized anti-infection therapy and preventive measures for thrombotic complications were implemented throughout the entire treatment course. Outcomes: After 72 h of intensive care and dynamic treatment adjustment, the patient's hemodynamic and respiratory status improved significantly and stabilized, and she was successfully weaned from mechanical ventilation. At the 30-day follow-up after discharge, the patient achieved complete recovery of organ function with no long-term sequelae or related complications. Lessons learned: This case indicates that clinicians should maintain a high degree of vigilance for the possibility of complicated PE in AFE patients, especially those with high-risk factors such as advanced age and operative delivery. Early identification via standardized diagnostic tools, seamless collaboration of the MDT, precise organ function support based on real-time monitoring, and dynamic adjustment of the treatment regimen according to the patient's condition are the core keys to improving the success rate of treatment and the prognosis of patients with AFE complicated with PTE.