Extracorporeal Membrane Oxygenation in Pregnancy

Pregnancy and the peripartum period are dynamic processes, encompassing a whole range of physiological changes in the patient. Managing a critically ill pregnant patient on extracorporeal membrane oxygenation (ECMO) involves juggling between their unique physiological changes, altered pharmacokinetics, appropriate anticoagulation, and obstetric management. Cesarean deliveries are most common due to improved hemodynamic control, fewer interruptions in ECMO flow, and speed of the delivery. Strict hemostasis and placement of prophylactic drains are a must to prevent post-partum hemorrhage. Increased stress of labor and normal delivery may hamper ECMO flows during contractions and may increase risk of heart failure, apart from physical limitations like inability to push effectively under sedation and difficulty in attaining lithotomy position. Induction of labor in these patients may necessitate labor analgesia.