Amniotic fluid embolism following artificial rupture of membranes leading to hypoxic-ischemic encephalopathy and persistent vegetative state: A case report

Amniotic fluid embolism (AFE) is a rare, catastrophic, and life-threatening condition that can occur during the peripartum period. It is thought to result from the entry of fetal cells and debris, present in amniotic fluid and rich in thromboplastin, into the maternal circulation, triggering disseminated intravascular coagulation (DIC), sudden cardiorespiratory collapse, and maternal and/or fetal deterioration. AFE remains a clinical diagnosis of exclusion, and management is primarily supportive. A 35-year-old woman at 40 weeks of gestation was admitted in active labor and underwent artificial rupture of membranes. Approximately two minutes later, she developed sudden and unexpected bradycardia, severe hypotension, cyanosis, and concurrent fetal bradycardia. On examination, the cervix was fully dilated; however, an attempted vacuum-assisted delivery during cardiopulmonary resuscitation (CPR) was unsuccessful, and an emergency cesarean section was performed. The neonate was transferred to the neonatal intensive care unit (NICU), while the mother was transferred to the intensive care unit (ICU) following cardiorespiratory arrest. DIC was diagnosed, and treatment for suspected AFE was initiated. Both the mother and neonate survived; however, the mother remained in a persistent vegetative state. This case highlights the critical importance of maintaining a high index of clinical suspicion for AFE in any parturient presenting with sudden bradycardia and hypotension. It further underscores the essential role of prompt multidisciplinary collaboration in optimizing maternal and neonatal outcomes.