Cardiopulmonary resuscitation in late pregnancy.

The most recent report on maternal mortality (1979-81) found that half the direct maternal deaths are .dueto acute causes,' hence resuscitation techniques must remain an essential part of the training of staff caring for pregnant women.In the third trimester of pregnancy resuscitation is complicated by compression of the aorta and vena cava by the uterus.'We describe a case in which caesarean section was performed as part of the resuscitation of the mother, resulting in survival of the mother and baby.Case report A 27 year old woman (gravida 2, para 1) was admitted to the casualty department at 38 weeks' gestation having collapsed at home about 10 minutes earlier.Her antenatal history had been uneventful, and there was no history of uterine contractions or ruptured membranes.On admission she was deeply cyanosed and apnoeic and had fixed, dilated pupils and no pulse.Cardiopulmonary resuscitation was started, she was intubated, and a right internal jugular line was inserted.An electrocardiogram of the mother showed asystole.She was tilted to the left lateral position, but resuscitation in this position proved difficult.Examination showed that the size of the uterus was compatible with her dates; the single fetus presented cephalically, and the fetal heart was not heard.Five minutes after admission a lower segment caesarean section was performed while the patient was on the casualty trolley.The amniotic liquor was stained with blood, but there was no evidence of placental abruption.A male infant was delivered within one minute.The uterus was atonic, and there was no bleeding during the operation.Cardiopulmonary resuscitation was continued throughout.Immediately after delivery the mother developed ventricular fibrillation, which was successfully treated with defibrillation.She was transferred to the intensive therapy unit 15 minutes after arrival.Results of tests on-a blood sample taken on admission were consistent with disseminated intravascular coagulation and showed amniotic squames consistent with amniotic fluid embolism (figure).Heavy vaginal