Atypical case of amniotic fluid embolism developing isolated disseminated intravascular coagulation

A 32-year-old primigravida underwent a cesarean section at 39 weeks and a male infant was born. Two hours later profuse vaginal bleeding was noted. After bilateral uterine artery embolization, the vaginal bleeding seemed to have been controlled. However, five hours and twenty minutes later she developed profuse vaginal bleeding again and fell into shock regardless of fluid resuscitation. An emergent subtotal hysterectomy was performed and she was diagnosed with disseminated intravascular coagulation (DIC) following surgery. Treatment for hemorrhagic shock and DIC was attempted with massive transfusion in association with continuous dopamine infusion. The total blood loss was estimated to be about 10,000 ml. On the third postoperative day DIC and hemorrhagic shock improved and ventilator weaning was accomplished, however she developed acute renal failure. Hemodialysis treatment for the following 16 days resulted in the improvement of renal function. She was discharged 41 day after delivery. Afterwards, it was realized that the plasma concentration of zinc coproporphyrin-I, a component of amniotic fluid, had considerably increased. Since there was no other cause for the severe bleeding, she should be diagnosed with amniotic fluid embolism (AFE). This case illustrates that AFE may develop an isolated DIC without antecedent hemodynamic or respiratory instability.