A 26-Year-Old Pregnant Woman With Ventricular Tachycardia and Shock

Abstract

(N Engl J Med. 2021;384:272–282) A 26-year-old patient, pregnant with monochorionic, diamniotic twins at 32 weeks gestation, was transferred to the hospital following cardiac arrest caused by ventricular tachycardia. This was the patient’s third pregnancy and the previous 2 were uncomplicated. One week before presenting to the hospital, the patient had a cough, sore throat and ear pain, and new edema in her legs. She was prompted to seek care at an emergency department when pain in her right leg progressed. While in the emergency department, painful contractions began, the cervix was 2 cm dilated, and preterm labor management began. There was no further cervical dilation after 24 hours but the patient remained hospitalized. After 5 days the edema had worsened, and an occlusive thrombus was found in the left peroneal vein. Intravenous heparin was administered. The next day, the patient experienced chest pain before becoming unresponsive. Monomorphic ventricular tachycardia was detected. Spontaneous circulation resumed after epinephrine and cardioversion were administered. The patient underwent tracheal intubation and then emergency cesarean section, which resulted in 2 health male infants and an intraoperative blood loss of 1600 mL.