Resuscitative hysterotomy for maternal collapse in a triplet pregnancy

We encountered a 47-year-old woman, at 35 weeks of gestation, carrying triplets, who attended the hospital with severe pre-eclampsia and at admission had eclamptic fit followed by cardiac arrest. Cardiopulmonary resuscitation was started when she did not respond to initial measures; resuscitative hy...

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Bibliographic Details
Published in:BMJ case reports 2020-07, Vol.13 (7), p.e235328
Main Authors: Tambawala, Zenab Yusuf, Cherawala, Masuma, Maqbool, Sadia, Hamza, Lama Khalid
Format: Article
Language:English
Subjects:
Abdomen
Blood pressure
Cardiopulmonary resuscitation
Case reports
Cesarean Section
CPR
Eclampsia
Embolisms
Female
Glucose
Heart Arrest - diagnosis
Heart Arrest - etiology
Heart Arrest - therapy
Heart failure
Humans
Hypertension
Hypoxia
Hysterotomy
In vitro fertilization
Intensive care
Medical prognosis
Midwifery
Obstetrics
Preeclampsia
Pregnancy
Pregnancy Complications, Cardiovascular - diagnosis
Pregnancy Complications, Cardiovascular - etiology
Pregnancy Complications, Cardiovascular - therapy
Pregnancy, Triplet
Reminder of Important Clinical Lesson
Uterus
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Summary:We encountered a 47-year-old woman, at 35 weeks of gestation, carrying triplets, who attended the hospital with severe pre-eclampsia and at admission had eclamptic fit followed by cardiac arrest. Cardiopulmonary resuscitation was started when she did not respond to initial measures; resuscitative hysterotomy was started on the site of collapse immediately, within 4 min postarrest, to deliver the triplets within 5 min postmaternal cardiac arrest. Timely decision of resuscitative hysterotomy done primarily to restore maternal cardiac output due to a grossly gravid uterus saved the mother and the triplets. With increasing maternal age and use of in vitro fertilisation resulting in multiple pregnancies, maternal comorbidities are more likely. These could result in maternal collapse in which case timely resorting to resuscitative hysterotomy can make survival of mother and feti more likely.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-235328