Maternal Cardiac Arrest During Cesarean Section in the Setting of Severe Preeclampsia and Uncontrolled Type 1...

Maternal cardiac arrest is an uncommon but life-threatening complication of pregnancy. Several maternal, social, and obstetric factors have been associated with increased risk, including older maternal age, underlying medical comorbidities, and hypertensive disorders of pregnancy. We present a case of maternal cardiac arrest during cesarean section in a patient with preeclampsia with severe features and uncontrolled type 1 diabetes. This case raises awareness for maternal morbidity and suggests cardiovascular risk and preconception counseling in high-risk obstetrical patients.  A 31-year-old G2P1001 at 32 weeks and 1 day of gestation presented with preeclampsia with severe features and uncontrolled type 1 diabetes. On hospital day 2, the patient developed pulmonary edema. Because of this, magnesium sulfate for seizure prophylaxis was discontinued, and delivery via repeat cesarean section was performed. During surgery, the patient became agitated, which persisted despite sedation. She had an episode of oxygen desaturation followed by bradycardia to 36 beats per minute. The patient was intubated, and asystole was recognized. Advanced cardiac life support was initiated, and the patient was resuscitated. The bedside echocardiogram showed an ejection fraction of 25-30%. She was diagnosed with cardiogenic shock and treated with vasopressors and insertion of an Impella device. The patient's condition was most likely exacerbated by her morbidities: preeclampsia with severe features and uncontrolled diabetes. Preeclampsia with severe features and diabetes can be considered as independent risk factors for maternal cardiac arrest. Diabetes and hypertension are known risk factors for heart disease, which can be amplified in the setting of physiologic changes that occur during pregnancy. This case demonstrates the role of cardiometabolic disease in peripartum cardiovascular collapse and emphasizes the importance of cardiovascular risk stratification, preconception counseling, and multidisciplinary surveillance in high-risk patients.