A102-24 Amniotic Fluid Embolism Presenting as Intraoperative Cardiopulmonary Arrest During Cesarean Delivery

Abstract Introduction Amniotic fluid embolism (AFE) is a rare but life-threatening obstetric emergency characterized by sudden hemodynamic instability, respiratory failure, and coagulopathy. Early recognition and rapid multidisciplinary intervention are essential to improving survival. Case Description A 28-year-old G2P0010 woman at 39 weeks and 1 day gestation presented for induction of labor. During labor, late fetal heart rate decelerations were noted. Despite administration of terbutaline and ephedrine, fetal distress persisted, prompting an emergent Cesarean section. Intraoperatively, the patient required intubation and subsequently developed pulseless electrical activity (PEA). She underwent seven minutes of advanced cardiac life support (ACLS), including three defibrillation attempts, before return of spontaneous circulation (ROSC) was achieved. A massive transfusion protocol (MTP) was activated, and she received three units of packed red blood cells, two units of fresh frozen plasma, one unit of platelets, and one unit of cryoprecipitate. She was transferred to the medical intensive care unit for post-arrest management and made a full neurologic recovery. Discussion AFE remains one of the leading causes of maternal mortality, with an incidence estimated between 1 in 20,000 to 1 in 50,000 deliveries. The proposed mechanism involves maternal exposure to amniotic fluid components, triggering an aberrant immune response, pulmonary vasospasm, and disseminated intravascular coagulation (DIC). Diagnosis is clinical, based on the sudden onset of cardiovascular collapse or coagulopathy without another identifiable cause. In this case, the abrupt intraoperative cardiac arrest without significant hemorrhage or anesthetic complications raised suspicion for AFE. The rapid, coordinated response—prompt initiation of ACLS, activation of MTP, and immediate critical care support—was crucial in achieving complete recovery. This case illustrates the importance of maintaining a high index of suspicion and ensuring effective multidisciplinary coordination among obstetric, anesthesia, and critical care teams. Conclusion AFE is a diagnosis of exclusion requiring immediate, aggressive management. This case demonstrates that survival with full recovery is achievable through early recognition, rapid resuscitation, and cohesive multidisciplinary intervention. Simulation-based training and institutional preparedness remain vital in optimizing outcomes for this unpredictable obstetric emergency. This abstract is funded by: None