Successful neonatal outcome after postmortem caesarean section at Sumbawanga Regional Referral Hospital, Rukwa, Tanzania: case report.

backgroundCardiac arrest in pregnancy can occur for a variety of reasons. During maternal cardiac arrest or shortly thereafter, the fetus may remain viable. Postmortem caesarean section can potentially save the fetus with or without long-term neurological sequelae; in the absence of timely intervention, however, fetal death is inevitable. Given the limited documentation in developing countries and the possibility of unfavourable outcomes, this report presents one of the few documented cases from resource-limited Sub-Saharan Africa describing a live birth with a sustained favourable neurological outcome following a postmortem caesarean section performed after maternal death from a dental abscess. This case expands the evidence base for the feasibility and value of such a procedure in settings lacking advanced critical care. We report the case of a 34-year-old multigravida at a gestational age of 36 weeks and 2 days, who was admitted to Sumbawanga Regional Referral Hospital as a referral from a lower facility, presenting with a painful left jaw swelling and a diagnosis of dental abscess. She had a one-month history of this swelling associated with fever, hoarseness of voice, and purulent discharge. Abdominal examination revealed a gravid uterus with fundal height of 36 cm, longitudinal lie, and cephalic presentation. There were no palpable contractions, and the fetal heart rate was 143 bpm. The patient was managed as a case of dental abscess in a near-term pregnancy. The dental team performed incision and drainage, and during the procedure, the patient developed cardiorespiratory arrest attributed to endotoxic septic shock secondary to the dental abscess. The exact cause of death, beyond endotoxic shock, could not be determined in the absence of an autopsy, and other potential causes of death cannot be definitely ruled out. Despite resuscitation attempts, the patient could not be saved and was pronounced dead. In consultation with the Obstetric team, an immediate postmortem caesarean section was performed, delivering a female neonate weighing 2600 g with an APGAR score of 6 and 8 in the 1st and 5th minutes, respectively. The newborn was admitted to the neonatal care unit for further management. At the time of this publication, the child is one year and nine months old and has no apparent neurological impairment, with normal developmental milestones.

conclusionDespite several limitations and the possibility of poor neonatal outcomes, a timely postmortem caesarean section performed at a favourable gestational age, in an appropriate setting with skilled personnel, basic equipment, and access to a neonatal care unit, can result in a live birth with good early neonatal outcomes even in a resource-limited environment.