MASSIVE PULMONARY EMBOLISM WITH INTRAOPERATIVE CARDIAC ARREST DURING ELECTIVE CESAREAN DELIVERY FOR PLACENTA PREVIA: A CASE REPORT
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Abstract
Venous thromboembolic complications (VTECs) and amniotic fluid embolism (AFE) remain among the leading causes of maternal mortality worldwide; however, the clinical presentation of massive pulmonary embolism (PE) and AFE on the operating table can be virtually indistinguishable, complicating timely diagnosis and management decisions. Existing standardized risk stratification scales for VTECs in pregnant women do not always identify high-risk patients before complications arise. This report presents the case of a 25-year-old patient admitted for an elective Cesarean section due to complete placenta previa and transverse fetal lie at term. Her prenatal VTEC risk score (based on the RCOG scale) was 0. Minutes after the delivery of the fetus and placenta under spinal anesthesia, the patient experienced sudden loss of consciousness, progressive bradycardia, arterial hypotension, and desaturation, progressing to ineffective cardiac activity and ventricular fibrillation; this necessitated halting the surgery and performing cardiopulmonary resuscitation, resulting in the restoration of spontaneous circulation within 6 minutes. The differential diagnosis between AFE and PE was resolved in favor of massive/submassive PE. This case report demonstrates that a life-threatening pulmonary embolism (PE) can occur intraoperatively even in a patient with no risk factors according to standardized scoring systems; furthermore, a rapid multidisciplinary response, immediate cardiopulmonary resuscitation, and the judicious choice of anticoagulation rather than thrombolysis in the early postoperative period can lead to a favorable maternal and perinatal outcome.
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