Extracorporeal cardiopulmonary resuscitation in a woman with twin pregnancy.

INTRODUCTION: Maternal cardiac arrest is a rare condition. Cardiopulmonary resuscitation (CPR) in pregnancy is different from that in other populations due to physiological changes in patients. Extracorporeal cardiopulmonary resuscitation (ECPR) is recommended in patients having cardiac arrest with potentially reversible etiologies. However, data regarding ECPR in pregnancy are limited. CASE SUMMARY: A 24-year-old woman with a 33-week twin pregnancy developed witnessed cardiac arrest in an antenatal clinic. She underwent perimortem cesarean delivery (PMCD) and ECPR, but uterine atony with massive bleeding occurred. Emergency hysterectomy and massive blood transfusion were performed in the emergency department and the patient was transferred to the intensive care unit after hemodynamics was stable. CONCLUSION: Cardiac arrest in pregnancy is a complex condition. Several aspects of management have not been evaluated. Prospective studies for improving the outcomes are needed.

Reference ranges for fetal septum primum excursion from 14 to 40 weeks' gestation.

OBJECTIVES: The purpose of this study was to establish reference ranges for septum primum excursion and the septum primum excursion index. METHODS: Normal singleton pregnancies with certain dates from 14 to 40 weeks' gestation were enrolled to acquire spatiotemporal image correlation volume data sets. The stored data sets were subsequently displayed offline to measure septum primum excursion and the left atrium diameter. The measured values were regressed to identify the best-fitted model as a function of gestational age and biparietal diameter. RESULTS: A total of 624 volumes were successfully measured, and normal reference ranges for predicting means and standard deviations of septum primum excursion and the septum primum excursion index were established based on best-fitted equations. The septum primum excursion index was relatively constant throughout pregnancy (mean ± SD, 0.474 ± 0.082), whereas septum primum excursion increased with gestational age and biparietal diameter as follows: (1) septum primum excursion = -6.30 + 0.667 × gestational age - 0.009 × gestational age(2); SD of septum primum excursion = 0.219 + 0.02 × gestational age; and (2) septum primum excursion = -3.342 + 1.933 × biparietal diameter - 0.102 × biparietal diameter(2); SD of septum primum excursion = 0.330 + 0.065 × biparietal diameter. Percentile charts for predicting septum primum excursion and equations for Z score calculation were also provided. CONCLUSIONS: Normal reference ranges for fetal septum primum excursion and the septum primum excursion index have been provided. These normative data may be useful tools for assessment of hemodynamics through the foramen ovale or left ventricular diastolic function.