A case of sudden multiple hematomas during cesarean section due to amniotic fluid embolism

• Published in: International journal of surgery case reports 2023-06, Vol.107, p.108342, Article 108342
• Main Authors: Tanabe, Shohei, Yoshimoto, Akiko, Sugino, Sachiyo, Ichida, Kotaro, Niiya, Kiyoshi, Morishima, Syuji
• Format: Article
• Language: English
• Subjects: Amniotic fluid embolism; Case Report; Cesarean section; Disseminated intravascular coagulation; Haematoma
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2023.108342

We report a case of multiple hematomas, a rare manifestation of amniotic fluid embolism (AFE), during cesarean section. The patient had a history of pregnancy and cesarean section birth due to placental abruption. At 38 weeks and 2 days, her membrane ruptured, and an emergency cesarean section was performed. During uterine suturing, hematomas suddenly formed in multiple locations, and bleeding began. Intraoperative blood tests revealed decreased hemoglobin and fibrinogen levels, leading to the administration of red blood cells and fresh frozen plasma. Despite initial transfusions, hemoglobin and fibrinogen levels did not increase, necessitating additional transfusions, which ultimately improved the hemoglobin and fibrinogen levels. A post-discharge blood draw showed decreased C3 levels, supporting a diagnosis of disseminated intravascular coagulation (DIC)-type AFE. The sudden onset of hematomas in multiple locations other than the uterine incision wound was an atypical presentation of AFE in this case. The multiple hematomas were caused by DIC-induced hemostasis, and the decreased C3 level in the blood test supported the diagnosis of DIC-type AFE. Multiple hematomas may occur as a symptom of DIC-type AFE and require attention. •The patient had multiple hematomas during cesarean section.•The right ovary was removed during hematoma repair.•Amniotic fluid embolism caused the bleeding.•This case shows the risks of amniotic fluid embolism and the need for prompt diagnosis and management.