A Woman With Sudden Cardiac Arrest After Caesarean Delivery.

A caesarean section was scheduled for a healthy 34-year-old woman, gravida 6, para 4, abortus 1, to deliver a breech baby at 37 weeks of gestation in a local clinic. Immediately after the delivery, she had a seizure followed by cardiac arrest. The team immediately initiated appropriate resuscitation and transferred her to a referral hospital. On arrival, she was in pulseless electrical activity, and achieved spontaneous circulation after 20 minutes. Point-of-care ultrasound revealed systolic dysfunction of left ventricle and multiple thrombi in the four cardiac chambers (Figure 1 and Video E1) and the inferior vena cava (Figure 1 and Video E2). Chest computed tomography showed multiple filling defects in the venous system, especially the right atrium, inferior vena cava, and ovarian veins (Figure 2).Figure 2Axial contrast-enhanced chest computed tomography image (left panel) showing thrombi (asterisk) in the right atrium. Axial contrast-enhanced abdomen computed tomography (right panel) showing thrombi (long arrow) in the inferior vena cava.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Peripartum cardiomyopathy with cardiac and venous thrombi. Despite rapid initiation of extracorporeal membrane oxygenation supports, the patient died. Peripartum cardiomyopathy is a rare type of dilated cardiomyopathy that has been linked to increased maternal morbidity and mortality.1Elkayam U. Tummala P.P. Rao K. et al.Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy.N Engl J Med. 2001; 344: 1567-1571https://doi.org/10.1056/NEJM200105243442101Crossref PubMed Scopus (415) Google Scholar It usually onsets between the last month of pregnancy and the fifth month postpartum.2McNamara D.M. Elkayam U. Alharethi R. et al.Clinical outcomes for peripartum cardiomyopathy in North America: results of the IPAC study (Investigations of Pregnancy-Associated cardiomyopathy).J Am Coll Cardiol. 2015; 66: 905-914https://doi.org/10.1016/j.jacc.2015.06.1309Crossref PubMed Scopus (308) Google Scholar Intracardiac thrombus in peripartum cardiomyopathy cases is a challenge to diagnose, and the most effective management strategy remains unclear.3Arany Z. Elkayam U. Peripartum cardiomyopathy.Circulation. 2016; 133: 1397-1409https://doi.org/10.1161/CIRCULATIONAHA.115.020491Crossref PubMed Scopus (239) Google Scholar eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJlZWNjNzkxYmFhNTlkYmQ4MGJlNDAwNzkyZTI0Nzc1YyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjk1MzEyMDI2fQ.I0mZxDn_ILv6vQicO_QTuO_ANKdyEE_-pnEYmffPo12dX2eb3BaeN1t2VeyfX0p4E7uO8nw8w6R-zR3eMmyZ_1dQcf642VUB5WxwjOsjBK4L8mxD9pC7ccI7cmxDZ6POEDB_ZWfTq15E9ilhSWp0ZMLwnzEGWohARZoToZexUceFXljWUgSIsG6-kY3wnchVJgH9K5dMNNnVVZ7XM3XWmvlAOish3uTAa542z96u9ob6HYit83NdO7waVD3UDfRxKyeJS7U4LPTqClOsbu262XmVy9OwKtD4OFkJGgkYKaO59f3Nd4jHFN3E_xXd5bnvc69HnClj98C6sb9BCsntGQ Download .mp4 (1.4 MB) Help with .mp4 files Video E1Multiple thrombi in the 4 heart chamberseyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI3YTc4MGNmMmM4ODYxZDNjMzVhYjk2OTg1NTUxNmQyMiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjk1MzEyMDI2fQ.oKLkN4-OeqKPSbxDCCxn98XGsaFItS_yORb4gaAO2FhbGWxNz-MIVCgF-Kob8zl-azzylaBcjvoYlRKkrgXs-7UCzrEs5V9w0GIURI-U8XwXfTbX9cxtCjZDeCLRStrSx9wgw6PM4sFxhupbq6TcLWkvvphBWHt-55huq70akD6Lc1alIJTjOzAaad6U4rHlBA8mU0NCe3GajzSX6NL97dqO3GxXwCJZG2Ja6Z3cnrruTWg_DRoKkdrWZdqhlmvOlM6UM5HXiE5G_AE-ARDmj8p0oNa2GXYBih_Emqee9XsOsU5_c0cO-lwENnxpDgojvD9QH7gZaS0mR2TqmExFwg Download .mp4 (0.49 MB) Help with .mp4 files Video E2Multiple thrombi in the inferior vena cava