Title : Live birth after perimortem caesarean delivery in a 27-year-old out-of-hospital cardiac arrest nulliparous woman
Abstract:
The perimortem caesarean section, as described in its name, is the surgical delivery of the foetus, performed during or near the time of death of the mother.
27-year-old holiday-maker from Germany on a Mediterranean beach in south of France, 36 week pregnant, no issues with pregnancy, no history of pre-eclampsia. Had a community VF-cardiac arrest, probably due to heat stroke. Fire-fighters onsite intervened immediately, D/C shock (automated external defibrillation AED) & CPR. 20 seconds non-flow cardiac arrest. Airway is secured by endotracheal tube. Could not retrieve the patient. Mobile ECMO team mobilized & arrived at the place in 30 minutes by helicopter. V-A ECMO was performed onsite & patient is transferred immediately to theatres by helicopter (eventually regained spontaneous circulation after half an hour). Emergency caesarean section was done immediately following heparin reversal by protamine. Male baby was delivered within 1 min, with a body weight of 2920 g and body length of 52 cm. The 1-min and 5-min Apgar scores were 0 and 5, respectively. The newborn received neonatal resuscitation and emergency intubation immediately after delivery and was then admitted to the neonatal intensive care. He received therapeutic hypothermia treatment for 72 h and erythropoietin transfusion to minimize hypoxic-ischemic encephalopathy. Patient was admitted to ICU for further management. Patient was extubated following 34 days’ treatment in ICU (the patient was successfully removed from ECMO after 9 days, patient experienced ECMO-related complications, including thrombocytopenia and intracranial haemorrhage (ICH)... Neither long-term neurological deficits nor cognitive dysfunctions for both mom & baby.
Despite the high incidence of major bleeding, ECMO for postpartum cardiac or respiratory failure showed excellent survival outcomes. ECMO is feasible in these patients and can be carried out with good outcomes in an experienced centre.
