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