Twin live birth after resuscitative cesarean delivery in a woman with eclampsia and cardiac arrest in a low-resource setting

BACKGROUND: Eclampsia, a severe complication of preeclampsia, is a leading cause of maternal mortality, particularly in low-resource settings. Cardiac arrest in pregnancy, though rare, carries a high mortality rate due to physiological changes complicating resuscitation. Perimortem cesarean section (PMCS) is a life-saving intervention performed during or immediately after maternal cardiac arrest to improve outcomes. This case report describes a twin pregnancy complicated by severe eclampsia, pulmonary edema, and cardiac arrest, culminating in PMCS. CASE PRESENTATION: A 29-year-old gravida 2, para 1 woman at 34 + 5 weeks' gestation with twins presented with severe epigastric pain, headache, and lower abdominal pain. She had a history of preeclampsia in a previous twin pregnancy and missed antenatal visits due to a doctor's strike. however, Aspirin prophylaxis status could not be confirmed from available records. On admission, she exhibited severe preeclampsia (210/149 mmHg), confusion, and pulmonary edema confirmed by chest X-ray. TDespite aggressive management, she developed seizures, frothy secretions, and cardiac arrest. Immediate CPR was initiated, but ROSC was not achieved. PMCS was performed within 6 minutes, delivering live twins. The mother did not survive, but both twins were successfully resuscitated and discharged without complications. CONCLUSION: This case highlights the importance of timely intervention in managing severe eclampsia and cardiac arrest in pregnancy. Despite challenges, the successful delivery of live twins via PMCS demonstrates the potential for favorable neonatal outcomes. The case underscores the need for preparedness, multidisciplinary coordination, and resource allocation in obstetric emergencies.