{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T16:05:01Z","timestamp":1784649901185,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric emergency characterized by sudden cardiorespiratory collapse, disseminated intravascular coagulation (DIC), and a high case-fatality rate. Because no confirmatory test exists, the diagnosis remains clinical and one of exclusion. We report a case of presumed AFE in a 39-year-old primigravida with uterine myomas, obesity, and chronic hypertension who underwent an elective primary cesarean delivery under spinal anesthesia. During manipulation of the placenta, the patient developed abrupt cardiovascular collapse requiring cardiopulmonary resuscitation, with return of spontaneous circulation followed by profound coagulopathy and refractory uterine atony. Management included goal-directed transfusion within a massive transfusion protocol, uterotonic therapy, a failed B-Lynch suture, supracervical hysterectomy, and a subsequent right oophorectomy for an ovarian-vein hemorrhage identified on imaging. Laboratory studies demonstrated an overt consumptive coagulopathy consistent with the International Society on Thrombosis and Haemostasis (ISTH) criteria, while a normal serum tryptase argued against an anaphylactic mechanism. The neonate was delivered in good condition (Apgar scores 9, 10, and 10 at 1, 5, and 10 min; umbilical-artery pH 7.38) and required no neonatal intensive care. The mother achieved full hemodynamic and neurological recovery. This case illustrates that survival from presumed AFE is achievable through early recognition, high-quality resuscitation, prompt correction of coagulopathy, and decisive surgical hemostasis, and it highlights the diagnostic reasoning required to distinguish AFE from its principal differential diagnoses.<\/jats:p>","DOI":"10.3390\/life16071207","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T15:17:52Z","timestamp":1784647072000},"page":"1207","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Presumed Amniotic Fluid Embolism Complicated by Disseminated Intravascular Coagulation and Refractory Postpartum Hemorrhage: A Case Report and Narrative Review"],"prefix":"10.3390","volume":"16","author":[{"given":"Yasmin","family":"Sch\u00e4ffter","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacology, Medical Campus Hamburg (UMCH), George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 22761 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Schmidbauer","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Medical Campus Hamburg (UMCH), George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 22761 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4096-4025","authenticated-orcid":false,"given":"Jos\u00e9","family":"Valles Fons","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Medical Campus Hamburg (UMCH), George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 22761 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Sch\u00e4ffter","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Medical Campus Hamburg (UMCH), George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 22761 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonah","family":"Bosserhoff","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Duisburg-Essen, 45117 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7520-1454","authenticated-orcid":false,"given":"Erika-Gy\u00f6ngyi","family":"B\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1097\/AOG.0000000000000107","article-title":"Amniotic fluid embolism","volume":"123","author":"Clark","year":"2014","journal-title":"Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.ajog.2016.06.037","article-title":"Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies","volume":"215","author":"Clark","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e2242842","DOI":"10.1001\/jamanetworkopen.2022.42842","article-title":"Association of pregnancy characteristics and maternal mortality with amniotic fluid embolism","volume":"5","author":"Mazza","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1097\/AOG.0b013e3181d9f629","article-title":"Incidence and risk factors for amniotic-fluid embolism","volume":"115","author":"Knight","year":"2010","journal-title":"Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Fitzpatrick, K.E., van den Akker, T., Bloemenkamp, K.W.M., Deneux-Tharaux, C., Kristufkova, A., Li, Z., Schaap, T.P., Sullivan, E.A., Tuffnell, D., and Knight, M. (2019). Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study. PLoS Med., 16.","DOI":"10.1371\/journal.pmed.1002962"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.ccm.2022.04.008","article-title":"Obstetric disorders and critical illness","volume":"43","author":"Griffin","year":"2022","journal-title":"Clin. Chest Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1097\/GCO.0000000000000218","article-title":"Amniotic fluid embolism: Despite progress, challenges remain","volume":"27","author":"Balinger","year":"2015","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_8","first-page":"1796","article-title":"Immune storm and coagulation storm in the pathogenesis of amniotic fluid embolism","volume":"25","author":"Yang","year":"2021","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1097\/OGX.0000000000000197","article-title":"Amniotic fluid embolism: Anaphylactic reactions with idiosyncratic adverse response","volume":"70","author":"Kobayashi","year":"2015","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_10","first-page":"e45678","article-title":"The anaphylactoid syndrome of pregnancy: Two autopsy cases","volume":"15","author":"Plantzas","year":"2023","journal-title":"Cureus"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1016\/S0140-6736(06)69607-4","article-title":"Maternal Health Study Group of the Canadian Perinatal Surveillance System. Amniotic-fluid embolism and medical induction of labour: A retrospective, population-based cohort study","volume":"368","author":"Kramer","year":"2006","journal-title":"Lancet"},{"key":"ref_12","unstructured":"Haftel, A., Engorn, B.M., and Engel, W.A. (2026, April 02). Amniotic fluid embolism, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK559107\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"B29","DOI":"10.1016\/j.ajog.2021.01.001","article-title":"SMFM Special Statement: Checklist for initial management of amniotic fluid embolism","volume":"224","author":"Combs","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1111\/1471-0528.13300","article-title":"Incidence, risk factors, management and outcomes of amniotic-fluid embolism: A population-based cohort and nested case-control study","volume":"123","author":"Fitzpatrick","year":"2016","journal-title":"BJOG"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.ejogrb.2023.12.034","article-title":"Amniotic fluid embolism: 20-year incidence and case-fatality trends in the United States","volume":"294","author":"Suissa","year":"2024","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"B16","DOI":"10.1016\/j.ajog.2016.03.012","article-title":"Amniotic fluid embolism: Diagnosis and management","volume":"215","author":"Pacheco","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"54","DOI":"10.4236\/ojog.2014.41010","article-title":"Amniotic fluid embolism (AFE): A review of the literature orientated on two clinical presentations\u2014Typical and atypical","volume":"4","year":"2014","journal-title":"Open J. Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1007\/s12630-021-02065-4","article-title":"The role of echocardiography in amniotic fluid embolism: A case series and review of the literature","volume":"68","author":"Simard","year":"2021","journal-title":"Can. J. Anaesth."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Andonotopo, W., Bachnas, M.A., Dewantiningrum, J., Pramono, M.B.A., Setiawan, C., Sulistyowati, S., Stanojevic, M., and Kurjak, A. (2025). Amniotic fluid embolism: A comprehensive review of diagnosis and management. J. Perinat. Med., Online ahead of print.","DOI":"10.1515\/jpm-2025-0161"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.ajog.2019.07.036","article-title":"Amniotic fluid embolism: Principles of early clinical management","volume":"222","author":"Pacheco","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/ACO.0000000000000328","article-title":"Amniotic fluid embolism: Update and review","volume":"29","author":"Sultan","year":"2016","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1055\/s-0041-1728833","article-title":"Massive transfusion protocols in obstetric hemorrhage: Theory versus reality","volume":"40","author":"Salmanian","year":"2023","journal-title":"Am. J. Perinatol."},{"key":"ref_23","unstructured":"Deutsche Gesellschaft f\u00fcr Gyn\u00e4kologie und Geburtshilfe (DGGG) (2026, April 04). Peripartale Blutungen, Diagnostik und Therapie. AWMF-Registernummer 015\/063. Available online: https:\/\/register.awmf.org\/assets\/guidelines\/015-063l_S2k_Peripartale_Blutungen_Diagnostik_Therapie_PPH_2022-09.pdf."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Committee on Practice Bulletins-Obstetrics (2017). Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet. Gynecol., 130, e168\u2013e186.","DOI":"10.1097\/AOG.0000000000002351"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1056\/NEJMra1513247","article-title":"Postpartum hemorrhage","volume":"384","author":"Bienstock","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1097\/AOG.0000000000002253","article-title":"Tranexamic acid for the management of obstetric hemorrhage","volume":"130","author":"Pacheco","year":"2017","journal-title":"Obstet. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1159\/000360537","article-title":"Amniotic fluid embolism induces uterine anaphylaxis and atony following cervical laceration","volume":"78","author":"Tamura","year":"2014","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1016\/S0140-6736(24)02102-0","article-title":"Tranexamic acid for postpartum bleeding: A systematic review and individual patient data meta-analysis of randomised controlled trials","volume":"404","author":"Ker","year":"2024","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1097\/ALN.0b013e31821bdcfd","article-title":"Use of recombinant factor VIIa in patients with amniotic fluid embolism: A systematic review of case reports","volume":"115","author":"Leighton","year":"2011","journal-title":"Anesthesiology"},{"key":"ref_30","first-page":"CD012964","article-title":"Antifibrinolytic drugs for treating primary postpartum haemorrhage","volume":"2","author":"Shakur","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_31","first-page":"187","article-title":"Amniotic fluid embolism and uterine atony: Two case reports and literature review","volume":"176","author":"Borovac","year":"2025","journal-title":"Wien. Med. Wochenschr."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/7\/1207\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T15:29:21Z","timestamp":1784647761000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/7\/1207"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":31,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["life16071207"],"URL":"https:\/\/doi.org\/10.3390\/life16071207","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]}}}