Amniotic fluid embolism complicated with pulmonary embolism during cesarean section: Management with TEE and ROTEM

We are presenting a case of amniotic fluid embolism with presentation of pulmonary embolism during Cesarean section. A 27- year-old healthy woman was admitted to our hospital for scheduled Cesarean section. Her past medical history was unremarkable without any allergies. In the operation room, spinal anesthesia was performed smoothly and a male neonate (2180 g, Apgar score: 8 to 9) was delivered. During operation, mother was alert without significant hemodynamic change. However, 2 min later, while delivery of the placenta, she became irritated, confused, and started to yell out. Hypotension (58/36 mmHg) and marked sinus bradycardia (32 beats/ min), combined with hypoxia (SpO2 70%) was presented. Then bradycardia rhythm turned to pulseless electrical activity. Cardiopulmonary resuscitation (CPR) with chest compression was performed immediately and Epinephrine 0.3 mg was administered intravenously. One minute later, she resumed spontaneous circulation. After trachea intubation, a radial arterial cannula and central venous catheter were set up.