On-Table Hypoxic Arrest: A Comparative Examination of Peripartum Cardiomyopathy and Pre-eclampsia

Pre-eclampsia (PE) and peripartum cardiomyopathy (PPCM) are two types of complications that can occur in pregnancy and the peripartum period. We present the successful management of a pre-eclamptic patient with severe, undifferentiated pulmonary oedema in pregnancy. Our patient presented at 35 + 5 weeks of gestational age with hypertension, delirium and severe hypoxaemia. She developed pulseless electrical activity after induction of general anaesthesia for a category one caesarean section. Resuscitation commenced, and a peri-mortem caesarean section was performed. Spontaneous circulation returned nine minutes after arrest. Post-operative evaluation in the intensive care unit revealed elevated natriuretic peptide levels, cardiomegaly and left ventricular ejection fraction of 20%-25%. Pulmonary oedema associated with PE and PPCM may have similar clinical features but may be distinguished with a targeted bedside echocardiogram. This guides disease-specific management and prognostication. Strategies to prevent severe hypoxaemia during laryngoscopy and intubation may also be considered. These cases require expert care and good inter-disciplinary team dynamics to ensure a favourable patient outcome.