Question

A female patient collapses soon after delivery. There is profuse bleeding and features of disseminated intravascular coagulation. Which of the following is the most likely etiology?

• A. Amniotic fluid embolism
• B. Uterine prolapse
• C. Peripartum cardiomyopathy
• D. Rupture of the uterus

Answer 1

The Correct Option is A

The scenario presented is a female patient who collapses shortly after delivery, accompanied by profuse bleeding and signs of disseminated intravascular coagulation (DIC). To identify the most likely etiology, we need to analyze the symptoms and correlate them with the given options. The key symptoms to focus on are sudden collapse, severe bleeding, and DIC, which are critical predecessors for this assessment.

The correct diagnosis is Amniotic fluid embolism. Here's why:

• Amniotic Fluid Embolism: This is a rare but severe complication of pregnancy that typically occurs during or shortly after labor. It involves the entry of amniotic fluid, fetal cells, hair, and other debris into the maternal circulation, triggering a severe anaphylactoid reaction. The condition is characterized by acute respiratory distress, cardiovascular collapse, and coagulopathy, often presenting as DIC. The rapid development of these symptoms post-delivery strongly aligns with the patient's presentation.
• Uterine Prolapse: While it can occur after childbirth, uterine prolapse does not generally lead to acute collapse, severe bleeding, or DIC.
• Peripartum Cardiomyopathy: This condition involves heart failure towards the end of pregnancy or in the months following delivery. While it can cause symptoms like difficulty breathing and fluid retention, it is not typically associated with acute collapse and DIC.
• Rupture of the Uterus: This condition could lead to severe hemorrhage and maternal collapse, but it lacks the direct link to cause DIC, differentiating it from amniotic fluid embolism in this context.

Therefore, considering the sudden onset of collapse, bleeding, and DIC, amniotic fluid embolism is the most logical diagnosis among the options provided.