Chief of Internal Medicine department SAN LUIS POTOSI, San Luis Potosi, Mexico
Disclosure(s):
Francisco Javier Marin, Sr.: No financial relationships to disclose
Background: Cardiac arrest during labor is a rare but catastrophic event associated with high maternal and fetal mortality.Its main causes include obstetric hemorrhage, hypertensive disorders of pregnancy, pulmonary embolism, and amniotic fluid embolism.²,³ Timely care through a multidisciplinary approach and advanced intensive care management are key determinants for improving maternal survival
Methods: We describe the clinical and therapeutic management of a case of intraoperative cardiorespiratory arrest during cesarean delivery, complicated by cardiogenic shock, including advanced cardiopulmonary resuscitation, urgent obstetric intervention, echocardiographic evaluation, and comprehensive hemodynamic management in the intensive care unit
Outcome: A 38-year-old woman with morbid obesity and uncontrolled chronic hypertension was admitted in labor after one week of upper respiratory symptoms. She arrived by ambulance with severe respiratory distress, oxygen saturation of 85%, tachycardia (145 bpm), metabolic acidosis (pH 7.21), and signs of acute fetal distress. An emergency cesarean section was performed, during which she developed cardiorespiratory arrest. Advanced cardiopulmonary resuscitation was initiated, achieving return of spontaneous circulation after three cycles.
The patient was transferred to the intensive care unit in severe cardiogenic shock, with hypotension (71/39) requiring mechanical ventilation with FiO₂ 100% and vasoactive support. Transthoracic echocardiography showed left ventricular dilation with reduced ejection fraction 33% global hypokinesis, restrictive diastolic dysfunction, mild pulmonary hypertension, and right ventricular dysfunction. Norepinephrine vasopressin, and levosimendan were started.
Respiratory viral panel was positive for human metapneumovirus and rhinovirus/enterovirus, and ribavirin was initiated. Due to leukocytosis and suspected secondary bacterial pneumonia, linezolid and meropenem were added. After 48 hours, significant hemodynamic and respiratory improvement was observed. Follow-up echocardiography showed recovery of ventricular function LVEF 52% and normalization of right ventricular parameters. The patient was successfully extubated, had no neurological sequelae, and was discharged from the ICU on day five.
Conclusion: Cardiac arrest during pregnancy is a complex critical care scenario requiring pregnancy-specific considerations and multidisciplinary management. This case highlights the challenges of cardio-obstetric care, the interaction between gestational hemodynamics and cardiac disease, and the importance of a dedicated cardio-obstetrics team to optimize outcomes.
