Right atrial and ventricular clot as a cause of peri-arrest during caesarean birth requiring immediate thrombectomy

Venous thromboembolic disease remains a leading cause of maternal morbidity and mortality. We report a case of a 30-year-old woman at 37⁺⁶ gestation with a history of thalassaemia intermedia and splenectomy. During pregnancy, she had been managed with frequent blood transfusions and enoxaparin. She was admitted for induction of labour, and during labour, she developed pre-eclampsia with severe features. Despite magnesium sulphate therapy, she had a short self-terminating seizure shortly after an epidural had been sited. A decision to proceed with an urgent caesarean birth under epidural anaesthesia was made. After birth, she had another seizure associated with oxygen desaturation. Bag-valve-mask ventilation was insufficient, prompting conversion to general anaesthesia and tracheal intubation, after which cardiac collapse developed. Resuscitation was initiated and bedside cardiac ultrasound revealed a large clot-in-transit through the right atrium and ventricle, prompting immediate transfer to cardiac theatres for thrombectomy. The thrombus was successfully removed. The patient recovered well and her trachea was extubated the next day. She was discharged in a stable condition 8 days later. This case highlights the critical role of point-of-care ultrasound in the prompt diagnosis of life-threatening conditions and guiding emergency interventions.