Resuscitative hysterotomy and mechanical circulatory support for maternal cardiac arrest secondary to pulmonary embolism in a patient with known placenta accreta spectrum: a case report

Maternal cardiac arrest is a rare but severe event in obstetrics, with outcomes largely dependent on effective multidisciplinary management. We report the case of a 30-year-old pregnant woman with placenta accreta spectrum (PAS), a large placental hematoma, and uterine dehiscence. During her inpatient stay, she was conservatively managed until 24 + 6 weeks, when she suffered sudden cardiac arrest due to massive pulmonary embolism. Resuscitative hysterotomy and mechanical circulatory support was performed and venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated following identification of intracardiac thrombus. The patient required emergency hysterectomy due to uncontrolled PAS bleeding, complicated by massive hemorrhage and coagulopathy. Despite the complexity and severity of the situation, both maternal and neonatal outcomes were ultimately favorable. The patient was discharged home without neurological deficits 26 days after cardiac arrest; the neonate was discharged in good health at term-equivalent age. This case highlights the need for individualized thromboprophylaxis and underscores the critical role of specialized centers in managing high-risk pregnancies. Multidisciplinary care, prompt emergency response, and advanced life support measures were key to the successful outcome in this life-threatening scenario.