Acute Respiratory Arrest in Pregnancy - AHRQ WebM&M: Case & Commentary

Acute Respiratory Arrest in Pregnancy

The Case
A 35-year-old woman was 38 weeks pregnant with twins (G3P2). When she developed acute onset of shortness of breath and hemoptysis (coughing up blood), her husband called 911. Shortly after paramedics arrived, the patient experienced a respiratory and cardiac arrest. CPR was administered, and she successfully regained a pulse. Upon hospital arrival, the patient was rushed to the operating room for emergency C-section. Two infants were delivered stillborn, with Apgar scores of 0 at 1, 5, and 10 minutes. The patient was transferred to the ICU with hypoxic encephalopathy; she eventually recovered.

Review of her medical records revealed that the patient had a history of chronic hypertension, which had worsened during her third trimester; it had been managed by increasing the dose of her chronic antihypertensive medication (labetalol). A few weeks prior to admission, after the patient complained of shortness of breath, her obstetrician prescribed her albuterol. Two days prior to admission, the patient presented to the obstetrics clinic with blood pressures (BPs) in the range of 170-210/100-125. Fetal non-stress testing was normal. At that visit, the nursing notes indicate some concern about preeclampsia. However, the physician did not order further evaluation, in part because "preeclampsia labs" had recently been performed and were found normal.

open here to see the full-text:
AHRQ WebM&M: Case & Commentary