Cesarean section in the setting of severe pulmonary hypertension requiring extracorporeal life support

We describe the use of veno-arterial extracorporeal membrane oxygenation (ECMO) in a 35-year-old female with severe fixed pulmonary hypertension who went into cardiogenic shock during a Cesarean section. Pregnancy in the presence of severe pulmonary hypertension is typically contraindicated due to high maternal mortality rates. This patient visited our hospital at 37 weeks of gestation after experiencing dyspnea and chest pain. Clinical evaluation revealed severe fixed pulmonary hypertension. At the time of the planned delivery, femoral lines were placed; in case of emergency, ECMO became necessary during the delivery. During delivery, the patient developed sudden hemodynamic collapse necessitating rapid cannulation and initiation of ECMO. She was stabilized pharmacologically and separated from ECMO after 2 days. The baby was delivered uneventfully, and the mother and child were discharged 1 month after delivery.