Different Clinical Courses with Severe Postpartum Coagulopathy in Two Cases Showing the Same Histological Findings those Local Amniotic Fluid Emboli

We report two cases of postpartum intractable bleeding with coagulopathy. Case 1: A 34-year-old low-risk woman at 39 weeks of gestation was admitted to our hospital. After an uneventful vaginal delivery, placenta separation failed. Ultrasonography revealed absence of placental lacunae suggesting a retained placenta with a lower possibility of placenta accreta. Manual separation was then attempted in the operating room with success. However, profound vaginal bleeding continued despite hemostasis with intrauterine balloon tamponade and oxytocin administration. She eventually underwent a subtotal hysterectomy. Histological examination showed amniotic fluid emboli in the uterine corpus and no placental tissue. Case 2: A 30-year-old woman at 38 weeks of gestation was referred due to atonic bleeding after a vacuum delivery. Enhanced computed tomography showed diffuse intravenous contrast extravasation within the uterus. Profound vaginal bleeding continued despite hemostasis with uterine artery embolization. She eventually underwent a subtotal hysterectomy. Histological examination showed amniotic fluid emboli in the uterine corpus. The presented cases had evident etiologies such as retained tissue or uterine atony those rarely need to invasive procedures for hemostasis, but eventually led to intractable bleeding, in which mucin emboli were confirmed in the uterine corpus of both cases. We should not exclude the possibility of potential mild amniotic fluid embolism among the group of postpartum intractable bleeding caused by any etiologies.