Author: Ismat Abedlrhman Alborhan Mohammed / Editor: Stephen Sheridan / Codes: CC12, SLO3, SLO6 / Published: 22/12/2025
A 34-year-old woman, gravida 2 para 1 (G2P1), presents to the emergency department at 40 weeks and 5 days gestation following an in vitro fertilization (IVF) pregnancy. She complains of severe epigastric pain and bilateral lower limb swelling. Her obstetric history includes one previous uncomplicated normal vaginal delivery five years ago. She has no significant medical or surgical history aside from rhinoplasty and reports poor antenatal follow-up. She denies any headache or visual disturbances.
On arrival, the patient was in hypertensive crisis with a blood pressure of 185/110 mmHg, and a urine dipstick demonstrated ++++ proteinuria. She was treated with intravenous labetalol (total 100 mg) and a loading dose of magnesium sulfate (4 g). Despite the severity of her condition, immediate caesarean delivery was not undertaken at this stage.
Shortly after receiving an epidural, the patient arrested in theatre in front of the multidisciplinary team, including obstetrics, anesthesiology. She is pulseless, prompting a Code Blue. Advanced Cardiovascular Life Support (ACLS) is initiated, and the monitor shows pulseless electrical activity (PEA). During cardiopulmonary resuscitation (CPR), an emergency resuscitative hysterotomy is performed on-site. After two CPR cycles and 1 mg of epinephrine, return of spontaneous circulation (ROSC) is achieved within five minutes.
A healthy baby girl is delivered, and post-ROSC echocardiography shows normal cardiac function with no evidence of pulmonary embolism or tamponade. The patient stabilizes with vasopressor support and is later extubated fully conscious, with no residual deficits. Initial labs reveal a significant post-delivery drop in hemoglobin and platelets, alongside markedly elevated liver enzymes.
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Good revision
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