Urgent Cesarean Section in a Patient on Venovenous Extracorporeal Membrane Oxygenation.

A G7P6 40-year-old female at 20 weeks gestation, with a history of polysubstance use disorder and hepatitis C, presented to the emergency department with severe shortness of breath and hypoxia requiring intubation. After a thorough workup, she was diagnosed with aspiration pneumonitis and was treated with a course of antibiotics. After progressing well, she was soon extubated and transferred to a subacute rehabilitation facility (SAR). There, she acutely decompensated, requiring readmission, reintubation, and venovenous extracorporeal membrane oxygenation (ECMO) cannulation. After a brief period of improvement, the patient became increasingly unstable with hypotension, anemia, and downtrending fibrinogen. Bedside imaging indicated a possible placental abruption. After extensive discussion among the care teams and patient's healthcare proxy, an urgent cesarean section was performed. Although the fetus was determined to be nonviable, the patient tolerated the procedure well and was eventually decannulated from ECMO and transferred to a SAR.

Anesthetic Management of an Obstetric Patient With Ehlers-Danlos and Wolff-Parkinson-White Syndromes.

A 31-year-old, primigravida, nullipara (G1P0) female with a past medical history of Ehlers-Danlos Syndrome (EDS), newly diagnosed Wolff-Parkinson-White Syndrome (WPW), and fetal breech presentation initially presented at 36+5 weeks gestation for an external cephalic version (ECV). The patient noted significant symptomatology related to her WPW which had worsened over the course of her pregnancy despite being started on oral metoprolol. Despite joint recommendations from the anesthesia and obstetric teams to combine the ECV with a same-day scheduled induction of labor or cesarean section, the patient declined. An epidural catheter was placed using ultrasound guidance and slowly titrated with 2% lidocaine; however, the ECV was unsuccessful. At 39 weeks gestation, the patient underwent an uncomplicated low transverse cesarean section under combined spinal-epidural anesthesia. The patient was discharged two days later in stable condition with a referral to an electrophysiologist. Here we describe the anesthetic preparation and management for an external cephalic version and subsequent cesarean section in a patient with these two rare conditions.