Abstract
A case of autopsy-proven amniotic fluid embolism (AFE) after a curettage procedure performed at 16 weeks gestation is described. This is believed to be the 1st fatal case of AFE reported in the U.S., although there have been nonfatal cases following curettage procedures reported previously. In this case, the thromboplastic property of the trophoblastic fragments led to the occurrence of disseminated intravascular coagulation (DIC). Analysis of previously reported cases of AFE and/or DIC have implicated labor-inducing techniques. Such instillation procedures can push amniotic fluid into the maternal circulation system. In the present case, however, cellular debris rather than the fluid as such, was the primary agent which precipitated AFE and DIC. DIC is a rare and potentially severe complication of curettage, occurring at a rate of 0-3/1000 2nd trimester procedures. The condition appears to depend on gestational age. Supportive treatment must be provided. Prompt cardiopulmonary resuscitation is necessary. Replacement of blood and clotting factors is called for in cases of DIC.
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