AMNIOTIC-FLUID EMBOLISM IN PROGRESS - A MANAGEMENT DILEMMA

Amniotic fluid (AF) embolism is a rare but catastrophic complication o f pregnancy. We present the first case where the debris was seen in th e maternal uterine veins at the time of cesarean section. During a ces arean delivery performed for deteriorating fetal status and in conjunc tion with massive hydramnios; air bubbles and vernix were observed in the left uterine vein and in an area of Couvelaire appearance of the u terine fundus. As the patient was clinically stable and desired retain ed fertility, a decision was made to attempt to contain the debris in the uterine vasculature. The infundibulopelvic ligament and uterine ar teries were ligated and the area of Couvelaire uterus was oversewn. Wi th the exception of a mild laboratory coagulopathy, which required no specific treatment, the patient did well. The area of Couvelaire uteru s is the likely portal for the debris seen in this patient's vasculatu re. Containment appears to have averted the AF embolism syndrome.