Successful management of amniotic fluid embolism with cardiac arrest and liver rupture: a case report.

Amniotic fluid embolism (AFE) is an unpredictable and critical obstetric emergency. Although infrequent, it carries a significant risk of mortality. AFE is typically characterized by abrupt circulatory and respiratory failures, along with disseminated intravascular coagulation (DIC). Another rare complication during pregnancy is spontaneous liver rupture, which poses a serious danger to both the mother and the fetus. AFE generally manifests suddenly during labor, delivery, or shortly after childbirth and is believed to be triggered by the entry of amniotic fluid components into the mother's bloodstream. Spontaneous liver rupture is more frequently observed in individuals with gestational hypertension, eclampsia, or hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. We report the case of a 34-year-old woman (G2P1) with no previous history of hypertension, preeclampsia/eclampsia, or HELLP syndrome. Her delivery was planned for at 40 weeks and 2 days of gestation. During labor, there were sudden drops in fetal heart rate, followed by the emergence of frothy sputum and a loss of consciousness. Although an urgent cesarean section was performed due to a high suspicion of amniotic fluid embolism, the patient still experienced repeated respiratory and cardiac arrests, accompanied by severe postpartum hemorrhage after the surgery. With the aid of venovenous extracorporeal membrane oxygenation (ECMO), surgical exploration revealed a simultaneous liver rupture. Through a collaborative multidisciplinary approach, the patient eventually made a full recovery. The successful management of both AFE and spontaneous liver rupture during pregnancy is exceedingly rare. This report examines pertinent cases and delves into the underlying pathophysiological mechanisms to improve prevention, diagnosis, and treatment strategies for similar occurrences.