Amniotic fluid (AF) embolism is a rare but catastrophic complication of 
pregnancy. We present the first case where the debris was seen in the maternal 
uterine veins at the time of cesarean section. During a cesarean delivery 
performed for deteriorating fetal status and in conjunction with massive 
hydramnios; air bubbles and vernix were observed in the left uterine vein and in 
an area of Couvelaire appearance of the uterine fundus. As the patient was 
clinically stable and desired retained fertility, a decision was made to attempt 
to contain the debris in the uterine vasculature. The infundibulopelvic ligament 
and uterine arteries were ligated and the area of Couvelaire uterus was 
oversewn. With the exception of a mild laboratory coagulopathy, which required 
no specific treatment, the patient did well. The area of Couvelaire uterus is 
the likely portal for the debris seen in this patient's vasculature. Containment 
appears to have averted the AF embolism syndrome.