# Urgent Cesarean Section in a Patient on Venovenous Extracorporeal Membrane Oxygenation

## TL;DR

A 40-year-old pregnant woman on ECMO required an urgent cesarean section after complications, resulting in a nonviable fetus but successful maternal recovery.

## Contribution

Presents a rare case of cesarean section during ECMO support in a high-risk pregnancy.

## Key findings

- The patient required ECMO due to aspiration pneumonitis and subsequent decompensation.
- An urgent cesarean section was performed despite the fetus being nonviable.
- The patient recovered well post-procedure and was successfully decannulated from ECMO.

## Abstract

A G7P6 40-year-old female at 20 weeks gestation, with a history of polysubstance use disorder and hepatitis C, presented to the emergency department with severe shortness of breath and hypoxia requiring intubation. After a thorough workup, she was diagnosed with aspiration pneumonitis and was treated with a course of antibiotics. After progressing well, she was soon extubated and transferred to a subacute rehabilitation facility (SAR). There, she acutely decompensated, requiring readmission, reintubation, and venovenous extracorporeal membrane oxygenation (ECMO) cannulation. After a brief period of improvement, the patient became increasingly unstable with hypotension, anemia, and downtrending fibrinogen. Bedside imaging indicated a possible placental abruption. After extensive discussion among the care teams and patient's healthcare proxy, an urgent cesarean section was performed. Although the fetus was determined to be nonviable, the patient tolerated the procedure well and was eventually decannulated from ECMO and transferred to a SAR.