Acute episode of itching and possible amniotic fluid embolism with circulatory collapse in a full term pregnant patient

Amniotic fluid embolism (AFE) is a rare but serious obstetric condition. Its presentation includes a variety of signs and symptoms, most commonly hypoxia, hypotension, cardiac arrest, disseminated intravascular coagulopathy (DIC) and severe bleeding. A 28-year-old G1P0 full-term patient was admitted for an acute severe itching episode. After ruling out cholestasis, induction of labor and epidural analgesia was started. No significant progress of labor was seen in the next several hours. Blood was seen soaking the epidural catheter site. This was thought of as possibly an early sign of DIC. The decision was made to perform an urgent cesarean section. The patient bled profusely in the operating room and her hemodynamic condition deteriorated. Aggressive resuscitation was performed. We hypothesized that the itching on admission was a possible indicator of early AFE.