Soon after an uncomplicated delivery at 38 weeks gestation, a mother develops respiratory difficulties and uncontrolled vaginal bleeding progressing to shock, multiorgan failure and death. At autopsy, masses of debris and epithelial squamous cells are apparent in the pulmonary microcirculation. Which of the following was the likely cause of death?

The diagnosis is amniotic fluid embolism, which is characterized by sudden respiratory difficulty, progressing to shock and often to death. Small pulmonary aerioles are packed with laminated swirls of fetal squamous cells. Sheehan syndrome is associated with obstetric blood loss, with resultant pituitary ischemia leading to postpaal hypopituitarism. Chorioamnionitis is infection of the placenta. Abruptio placentae is premature separation of the placenta and can lead to antepaal bleeding and fetal death. Amniotic fluid embolism and abruptio placentae are well-known causes of DIC.