Amniotic Fluid Embolism

We report a case of 34-year patient who had uncomplicated elective caesarean-section. Postoperatively, she developed sudden hypotension, bradycardia, dyspnea and disseminated intravascular coagulation (DIC), all signs associated with amniotic fluid embolism (AFE). Echocardiogram showed signs of acutely increased right ventricular after load including McConell's sign, i.e. right ventricular dilatation, segmental hypokinesia (mid-right ventricular) and hypercontractile right ventricular apex and overall right ventricular dysfunction. Similarly, 60/60 sign was positive on echocardiography (decreased right ventricular acceleration time of less than 60 milli-seconds and pulmonary artery systolic pressure of less than 60 mmHg). Performance of CT pulmonary angiogram failed to show any clear thromboembolic phenomenon; although, there were other indirect signs pointing towards the diagnosis. She was treated with aggressive supportive care without anticoagulation and she showed complete recovery, with follow-up echocardiogram becoming absolutely normal after 9 days with normalization of right ventricular size and function and improvement in 60/60 sign.