Perimortem cesarean delivery（PMCD）for cardiopulmonary arrest during induced labor under epidural analgesia: a case report

<p> PMCD may improve the circulatory dynamics of pregnant women in cardiopulmonary arrest and assist in resuscitation, and clinicians believe that immediately initiating PMCD after the onset of cardiac arrest reduces mortality for pregnant women. We report a case in which we performed PMCD to save the lives of a pregnant woman and her baby after the occurrence of cardiac arrest during a planned induced labor with epidural analgesia.</p><p> A 34-year-old primipara with an uneventful pregnancy and no relevant medical history or allergies developed CPA during planned painless delivery under epidural anesthesia at 39 weeks and 2 days of gestation. During transport to our hospital, she alternated between regaining spontaneous circulation and going into cardiopulmonary arrest. PMCD was started under general anesthesia in the catheter room, and the newborn was delivered 8 min after arrival at the hospital. Bleeding from the uterine incision continued after suture-based closure of the uterine muscle, so we packed gauze into her pelvis and used the vacuum-packing technique for secure wound closure. After the operation, she was admitted to the intensive care unit. Uterine bleeding persisted, so a supracervical hysterectomy was performed. Twenty-two months after the operation, the mother had short-term memory impairments, but she had neither mental nor motor disability. The baby was born with severe asphyxia, so targeted temperature management was implemented. However, 22 months after birth, the baby had severe motor and mental disabilities due hypoxic ischemic encephalopathy. The baby is still on a ventilator. In the future, we aim to introduce a protocol for PMCD based on thorough discussions with multidisciplinary medical teams.</p>