Kudo Takako, Kaga Akimune, Akagi Kozo, Iwahashi Hideki, Makino Hiromitsu, Watanabe Yoko, Kawamura Takae, Sato Taiju, Shinozaki Tsuyoshi, Miwa Shinya, Okazaki Nobuo, Kure Shigeo, Nakae Shingi
Division of Neonatology, National Hospital Organization Sendai Medical Center, 2-8-8 Miyagino, Miyagino-ku, Sendai 980-8520, Japan.
BMC Res Notes. 2014 Nov 20;7:821. doi: 10.1186/1756-0500-7-821.
Cardiopulmonary arrest in pregnancy has a very high maternal and fetal mortality rate. We report a case of successful maternal and neonatal survival in association with emergency cesarean section of a schizophrenic pregnant patient. To our knowledge, this is the first reported case of cardiopulmonary arrest in a pregnant woman with schizophrenia.
The parents were Japanese. The mother was 39 years old and had no history of prior pregnancy. Her admission to our hospital at 36 weeks and 4 days of pregnancy was due to deterioration of schizophrenia. On the first day of hospitalization, she collapsed after a seizure and vomiting, and an emergency resuscitation team was called immediately. The team identified apparent aspiration and successfully resuscitated the patient after 11 minutes of cardiopulmonary arrest. An emergency cesarean section was performed in the operating room. The newborn male infant received bag and mask ventilation at birth, and his Apgar scores were 5 at 1 minute and 8 at 5 minutes. He had a myoclonic seizure on the 2nd day of life: however, he experienced no further seizures on anticonvulsant medication after that episode. On the 18th day of life, magnetic resonance imaging of his brain revealed bilateral small hyperintensities on T1-weighted images in the basal ganglia. The mother and her newborn were discharged from our hospital without neurological disorders.
We speculate that the cause of cardiopulmonary arrest was aspiration due to seizure, and it is possible that a neurological response was evoked by administration of antipsychotic drugs and/or by eclampsia. Medical staff must be aware of the possibility of cardiopulmonary arrest in pregnant women with schizophrenia.
妊娠期心脏骤停的孕产妇和胎儿死亡率非常高。我们报告一例精神分裂症孕妇成功实现母婴存活并进行急诊剖宫产的病例。据我们所知，这是首例报道的精神分裂症孕妇发生心脏骤停的病例。
患儿父母为日本人。母亲39岁，既往无妊娠史。她因精神分裂症病情恶化于妊娠36周零4天时入院。住院第一天，她在癫痫发作和呕吐后晕倒，立即呼叫了紧急复苏团队。该团队发现明显的误吸，并在心脏骤停11分钟后成功使患者复苏。在手术室进行了急诊剖宫产。新生男婴出生时接受了面罩气囊通气，其1分钟Apgar评分为5分，5分钟时为8分。他在出生后第2天出现肌阵挛性癫痫发作：然而，在那次发作后使用抗惊厥药物治疗后未再出现癫痫发作。出生后第18天，他的脑部磁共振成像显示基底节T1加权图像上有双侧小的高信号。母亲和她的新生儿出院时无神经系统疾病。
我们推测心脏骤停的原因是癫痫发作导致误吸，并且抗精神病药物的使用和/或子痫可能引发了神经反应。医护人员必须意识到精神分裂症孕妇发生心脏骤停的可能性。
