Resuscitative hysterotomy for maternal collapse in a triplet pregnancy

• Published in: BMJ case reports Vol. 13; no. 7; p. e235328
• Main Authors: Tambawala, Zenab Yusuf, Cherawala, Masuma, Maqbool, Sadia, Hamza, Lama Khalid
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 06.07.2020; BMJ Publishing Group
• Series: Case report
• Subjects: Abdomen; Blood pressure; Cardiopulmonary resuscitation; Case reports; Cesarean Section; CPR; Eclampsia; Embolisms; Female; Glucose; Heart Arrest - diagnosis; Heart Arrest - etiology; Heart Arrest - therapy; Heart failure; Humans; Hypertension; Hypoxia; Hysterotomy; In vitro fertilization; Intensive care; Medical prognosis; Midwifery; Obstetrics; Pregnancy; Pregnancy Complications, Cardiovascular - diagnosis; Pregnancy Complications, Cardiovascular - etiology; Pregnancy Complications, Cardiovascular - therapy; Pregnancy, Triplet; Reminder of Important Clinical Lesson; Uterus; heart failure; pregnancy
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-235328

We encountered a 47-year-old woman, at 35 weeks of gestation, carrying triplets, who attended the hospital with severe pre-eclampsia and at admission had eclamptic fit followed by cardiac arrest. Cardiopulmonary resuscitation was started when she did not respond to initial measures; resuscitative hysterotomy was started on the site of collapse immediately, within 4 min postarrest, to deliver the triplets within 5 min postmaternal cardiac arrest. Timely decision of resuscitative hysterotomy done primarily to restore maternal cardiac output due to a grossly gravid uterus saved the mother and the triplets. With increasing maternal age and use of in vitro fertilisation resulting in multiple pregnancies, maternal comorbidities are more likely. These could result in maternal collapse in which case timely resorting to resuscitative hysterotomy can make survival of mother and feti more likely.