Maternal Cardiac Arrest in Severe Preeclampsia at 34 Weeks: Successful Resuscitation, Perimortem Cesarean Section, and Dual Survival

Maternal cardiac arrest is an uncommon, devastating event that requires rapid, coordinated action from multiple specialties to give both mother and baby the best chance of survival. We report a 29-year-old woman at 34 weeks and two days of gestation who came to the emergency department with severe preeclampsia and respiratory distress, eventually leading to cardiac arrest. Immediate cardiopulmonary resuscitation (CPR) was started with left uterine displacement (LUD), and return of spontaneous circulation (ROSC) was achieved after five cycles. A lower-segment cesarean section was performed right away, with the baby delivered 15 minutes after ROSC. The neonate was delivered in a state of cardiac arrest, necessitating immediate resuscitation and subsequent admission to the neonatal intensive care unit (NICU). The mother required invasive mechanical ventilation, antihypertensive therapy, and other supportive care. She was discharged to the ward on the third day and was ultimately discharged without apparent neurological sequelae. This case highlights the critical importance of rapid identification and execution of perimortem cesarean section (PMCS) for maternal cardiac arrest to optimize maternal and neonatal survival outcomes. Although perimortem delivery is ideally undertaken within the first few minutes, this case suggests that decisive clinical judgment and effective multidisciplinary coordination, combined with continued high-quality CPR, can yield favorable outcomes even when delivery occurs after 15 to 20 minutes.