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Cardiac Arrest during a C-section in a 24 year old with ARDS
Abstract Number: 107
Abstract Type: Case Report/Case Series
ARDS in a patient at 30 weeks gestational age with possible fetal bradycardia, is this an indication for an emergent C-section? Will this provide a better outcome for the mother, baby or neither? What should we treat first?
This is a case of a 24-year-old Female at 30 weeks gestational age, who developed ARDS secondary to pyelonephritis. After emergent intubation it became difficult to relocate the fetal HR possibly due to fetal bradycardia. The patient was urgently rushed for a STAT C-section and after the baby was delivered went into cardiac arrest on the operating table. The patient was resuscitated and the abdomen closed when she coded a second time while still in the OR. The patient was resuscitated again and remained comatose for 2 weeks in the ICU with anoxic brain injury. Over the following 3 months the patient gradually regained conciousness and some cognitive function.
There is very little evidence if any that C-section in patients with ARDS does anything to improve or worsen outcomes. One study suggested that early delivery in the third trimester may improve outcome except in women where etiology of ARDS was pyelonephritis or varicella pneumonia as a cause of respiratory compromise. The general principle of treating the mother is the best support for the fetus seems to be the most accepted way of dealing with ARDS in pregnancy. One salient point that can be gleaned from our case is that when a decision is made to c-section a patient in ARDS a multi disciplinary approach between the obstetrician, anesthesiologist, intensivist, pediatrician and most importantly patient and family should be sought. All the risks and benefits need to be explained and the team approach should be clearly defined as to who the procedure is intended to benefit.
Acute respiratory distress syndrome in pregnancy Crit Care Med. 2005 Oct;33(10 Suppl):S269-78 Cole DE, Taylor TL, McCullough DM, Shoff CT, Derdak S. Pulmonary and Critical Care Flight, Wilford Hall Medical Center, Lackland Air Force Base, TX, USA.
Acute respiratory distress syndrome in pregnancy and the puerperium: causes, courses, and outcomes.Obstet Gynecol. 2001 May;97(5 Pt 1):760-4 Catanzarite V, Willms D, Wong D, Landers C, Cousins L, Schrimmer D.Department of Maternal-Fetal Medicine, Sharp Mary Birch Hospital for Women, San Diego, California 92123, USA.