Massive non-surgical hemorrhage induced by amniotic fluid embolism during cesarean hysterectomy for placenta percreta with placenta previa: a case report

Amniotic fluid embolism (AFE) can give rise to disseminated intravascular coagulation (DIC), which can result in life-threatening obstetric hemorrhages. There are no reported cases where sudden onset massive pulmonary and intestinal hemorrhages were the main mode of blood loss due to AFE in English literature. A 37-year-old woman who had previously been diagnosed with placenta percreta invading her bladder with placenta previa presented to our hospital with abdominal pain. Her period of gestation was 34 weeks and 6 days. An ultrasound scan showed a single live fetus with placenta accreta spectrum, and no abruption was seen. There was no bleeding, and mother and fetus were stable. Ten hours after her admission, a sudden vaginal bleeding necessitated an emergency cesarean hysterectomy. A healthy boy was delivered, and a minor fresh abruption was noted. 25 min later, the patient experienced a sudden cardiac arrest. She was temporarily resuscitated. She suffered a second cardiac arrest, which was complicated by massive pulmonary hemorrhage (approximately 4500 mL) and gastrointestinal hemorrhage. The surgical blood loss was only 1500 mL. This patient died despite resuscitation attempts. Post-mortem histological examinations of the patient’s lungs and other organs revealed evidence of AFE and DIC and confirmed placenta percreta invading the urinary bladder. This is an extremely rare case of massive pulmonary and intestinal hemorrhage following AFE in a patient with placenta percreta and placenta previa. Placenta percreta and placenta previa would have increased her risk of getting AFE. Greater emphasis is needed on the primary prevention of the increasing global incidence of placenta percreta (part of the placenta accreta spectrum).