A Strategy of Bundle Transfusion for Amniotic Fluid Embolism-Induced Disseminated Intravascular Coagulation: Report of Two Cases

Aim: Amniotic fluid embolism (AFE) is a potentially lethal obstetric emergency with a high maternal mortality rate. Our report details two successful cases of patients who developed non-overt disseminated intravascular coagulation (DIC) following cesarean section, likely induced by AFE, and were managed using a bundle transfusion strategy prior to experiencing massive postpartum hemorrhage. Methods: An aggressive bundle transfusion strategy was initiated upon early laboratory evidence of coagulopathy (notably hypofibrinogenemia and prolonged clotting time) in suspected amniotic fluid embolism and administered as a rapid, near-simultaneous combination of tranexamic acid, fibrinogen concentrate, prothrombin complex concentrate, cryoprecipitate, and blood components. Results: The bundle transfusion strategy effectively corrected coagulation dysfunction before the condition progressed to DIC and postpartum hemorrhage. Discussion: This case report provides a reference for transfusion strategies in non-overt DIC induced by AFE, but the risks associated with bundle transfusion warrant further evaluation in future studies. Conclusion: The successful treatment of both cases is due to early detection of AFE and aggressive management of coagulopathy before clinical DIC presented. Synopsis: We report two successful treatment cases due to early detection of AFE and aggressive management of coagulopathy before clinical DIC presented.