Background: Almost 1 in 12,000 births result in a maternal cardiac arrest; the incidence of which is higher among women with factors such as hypertension, diabetes, hemorrhage, abnormal placentation, and advanced maternal age.
Case description: A 48-year-old primigravida, known hypertensive and diabetic and conceived by fetal embryo transfer was referred at 29 weeks and 1 day of gestation with painless bleeding P/V and was diagnosed with placenta previa. She was managed conservatively and given steroids for fetal lung maturity and magnesium sulfate for neuroprotection. She had a similar episode 10 days later, and 2 days after this, in the middle of the night she had profuse painless bleeding, and fetal heart rate of twin 2 was nonreassuring. The patient was taken up for emergency cesarean section and given general anesthesia. After delivery of the twins, the patient developed ventricular fibrillation. She was resuscitated within 3 minutes and monitored in the ICU. Both the twins were of low birthweight and admitted in the NICU. The patient gradually recovered and was discharged on postoperative day 9. The babies were discharged 1 month after birth.
Conclusion: The cause of the ventricular fibrillation was multifactorial and involved autonomic imbalance, hypovolemia, the stress of advanced maternal age and comorbidities such as hypertension and diabetes mellitus.
Clinical significance: It is important to be aware of the etiolo- gy and management of a cardiac arrest and blood loss during pregnancy and labor. C-sections must be avoided as much as possible in an advanced maternal age group.
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