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Cardiac Arrest during Cesarean Section - A Case Report and Review of the Differential Diagnosis
Stefan Lukac1, Sebastian Mayer2, Kathrin Mühlen3
1Department of Obstetrics and Gynecology, Ulm University, Ulm, Germany.
Insights
Peripartum cardiac arrest is rare but life-threatening. This review explores differential diagnoses, highlighting multifactorial causes beyond typical conditions, crucial for immediate intervention in pregnant women.
Area of Science:
- Obstetrics and Gynecology
- Cardiology
- Critical Care Medicine
Background:
- Peripartum complications cause significant maternal mortality globally.
- Peripartum cardiac arrest is a critical obstetric emergency requiring prompt diagnosis and management.
- The American Heart Association's BEAU-CHOPS scheme provides a framework for differential diagnosis.
Observation:
- A case of cardiac arrest during cesarean delivery in a 40-year-old G5/P3 patient is presented.
- Typical causes of peripartum cardiac arrest (bleeding, embolism, anesthetic complications, cardiovascular disease, eclampsia, sepsis) were considered and ruled out.
- The patient's cardiac arrest was suspected to be multifactorial, involving cardio-inhibitory reflexes from hypovolemia, obesity, advanced maternal age, and spinal anesthesia.
Findings:
- Cardiac arrest in pregnancy necessitates a thorough differential diagnosis.
- Exclusion of common causes is paramount before considering less typical etiologies.
- Physiological reflexes, patient risk factors, and anesthetic interventions can contribute to peripartum cardiac arrest.
Implications:
- Promptly identifying the cause of peripartum cardiac arrest is vital for improving maternal survival rates.
- Clinicians should consider a broad differential diagnosis, including less common causes, in managing peripartum cardiac arrest.
- Understanding the multifactorial nature of peripartum cardiac arrest can guide preventative strategies and treatment protocols.
Aim:
According to the World Health Organization, approximately 810 pregnant women die every day as a consequence of peripartum complications. A large proportion of deaths happen in developing countries. Peripartum cardiac arrest is a rare event that must be treated immediately. It is important to consider the differential diagnoses in order to save lives.
Methods:
In this review, we discuss a differential diagnosis of cardiac arrest according to the BEAU-CHOPS scheme of the American Heart Association in the relation to the case report of our 40-year-old G5/P3 patient who went into cardiac arrest during cesarean delivery.
Results:
Typical differentials for cardiac arrest during labor are bleeding, embolism, anesthetic complications, cardiovascular diseases, eclampsia, and sepsis. All of them were considered and ruled out in this patient. In the end, we suspect that physiological cardio-inhibitory reflexes triggered by sudden profound hypovolemia after placental separation along with the patient's risk factors, especially obesity and maternal age, and the administration of spinal anesthesia all potentially contributed to the cardiac arrest.
Conclusions:
This review highlights that the cardiac arrest during labor can be triggered by the multifactorial etiology, but firstly the typical differential diagnosis needs to be excluded.
