Amniotic Fluid Embolism With Maternal and Neonatal Survival in the Setting of Previously Undiagnosed Placenta Accreta Spectrum 3D: A Case Report

Amniotic fluid embolism (AFE) is a rare and life-threatening obstetric emergency characterized by sudden cardiopulmonary collapse and coagulopathy. Diagnosis remains clinical, and one of exclusion, as presentation may overlap with other causes of maternal cardiovascular collapse and hemorrhage. Here we present a 34-year-old woman, gravida 7 para 2133, at 33 weeks and one day gestation with known complete placenta previa who presented with vaginal bleeding and painful uterine contractions. Ultrasound performed two weeks prior demonstrated complete placenta previa without sonographic evidence of placenta accreta spectrum (PAS). Following cesarean delivery, the patient developed acute respiratory distress and pulseless electrical activity (PEA) arrest requiring cardiopulmonary resuscitation with return of spontaneous circulation after approximately 10 minutes. Massive transfusion protocol was initiated, and cesarean hysterectomy was performed after the identification of an abnormally adherent placenta. Final pathology demonstrated PAS grade 3D (previously known as placenta percreta), a condition associated with an increased risk of AFE, with extensive myometrial invasion and serosal disruption. The operative course was further complicated by disseminated intravascular coagulopathy, massive hemorrhage, acute respiratory distress syndrome, and severe urologic injury. Despite substantial postoperative morbidity requiring later urinary diversion surgery, both maternal and neonatal survival were ultimately achieved. This case highlights the diagnostic complexity of AFE occurring concurrently with catastrophic hemorrhage from previously undiagnosed PAS and emphasizes the importance of rapid multidisciplinary management and evidence-based protocols in optimizing outcomes.