Amniotic fluid embolism: a cause of sudden maternal death and police inquest

Amniotic fluid embolism (AFE) is a rare, unforeseeable, unpreventable, and dreadful complication of pregnancy. Histological diagnosis is still the criterion standard for its detection because of the lack of any reliable clinical laboratory tests. The diagnosis of AFE has a close association with medicolegal aspects of obstetric death. Amniotic fluid embolism occurs when massive amount of amniotic fluid abnormally enters the maternal venous system. We report a case of a 33-year-old healthy woman (G2, P2, L1) admitted to a private nursing care hospital with 37 weeks gestation for delivery. She normally delivered a healthy 2.8-kg infant boy. After 15 minutes of delivery, she developed tonic-clonic seizures, breathlessness, and loss of consciousness and died within 4 hours after onset of symptoms. The sudden death of a healthy mother led to medical negligence claim by the relatives, and a police case was filed against the private nursing care obstetrician. Despite a brief clinical history, meticulous microscopic examination of lungs revealed pulmonary microvasculature filled with fetal squamous cells, hair, and mucin. The final cause of sudden maternal death was given as AFE and pulmonary edema. This report highlights the importance of detailed microscopic examination of lungs and the need to study as many histopathologic sections as possible to rule out this entity.