Postpartum Acute Respiratory Distress Syndrome (ARDS) in a Patient with Suspected Amniotic Fluid Embolism After Complicated Childbirth

Abstract

A 33-year-old female patient developed acute respiratory distress syndrome (ARDS) after complicated childbirth in an external hospital. According to the reports from the external obstetrics center, severe postpartum hemorrhage, symptoms of shock, and a sudden episode with a decrease in peripheral oxygen saturation to 80% were observed after regular delivery of the complete placenta. Compromised coagulation was described. After operative bleeding control, a sudden ventricular tachycardia with consecutive cardiac arrest and need for brief cardiopulmonary resuscitation was reported. Consecutively, multiorgan failure developed, including ARDS and acute renal failure. Amniotic fluid embolism was the most probable differential diagnosis. ARDS management involved veno-venous extracorporeal membrane oxygenation (VV-ECMO), nitric oxide inhalation, and prone positioning. In the further course, the patient stabilized and started to recover from organ dysfunction. She presented with adequate neurological outcome after sedation weaning. Having experienced this life-threatening event in the vulnerable postpartum phase, the patient reported depressive symptoms. She was primarily separated from her newborn during ICU stay. With this case presentation, we aim to highlight and discuss two relevant topics: (a) clinical presentation and therapeutic management of postpartum ARDS after suspected amniotic fluid embolism, which is a rare, life-threatening birth complication, and (b) the psychological burden of being treated in the intensive care unit (ICU) after complicated childbirth.