1*Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga
2Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
3Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga/ Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Introduction: Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality worldwide. In rare instances, massive exsanguination can lead to maternal cardiac arrest, necessitating immediate and aggressive multidisciplinary intervention. Intraoperative Internal Manual Aortic Compression (IMAC) is a simple, equipment-free technique to achieve temporary hemostasis, yet its role during active cardiac arrest is underreported.
Case Report: We present the case of a 33-year-old multiparous woman with a history of chronic hypertension superimposed with severe preeclampsia. Following a cesarean section at 34 weeks of gestation, she presented with massive vaginal bleeding and hemodynamic instability. An emergency exploratory laparotomy was performed. Intraoperatively, the patient suffered a precipitous hemodynamic collapse, progressing rapidly to bradycardia and asystole. Advanced Cardiac Life Support (ACLS) protocols were immediately initiated, including chest compressions, mechanical ventilation, and intravenous epinephrine. Simultaneously, the surgical team performed intraoperative Internal Manual Aortic Compression (IMAC) to arrest distal blood flow to the pelvis. Return of Spontaneous Circulation (ROSC) was achieved shortly after the initiation of aortic compression.
Conclusion: The patient demonstrated complete neurological recovery within 48 hours and was discharged in good condition after 14 days. This case illustrates that in the setting of intraoperative cardiac arrest due to refractory PPH, IMAC serves as a crucial, life-saving temporizing maneuver. It effectively facilitates resuscitation by preserving central blood volume for vital organs, bridging the gap to definitive surgical hemostasis.
Keywords: Postpartum Haemorrhage, Intraoperative Internal Manual Aortic Compression, Obstetric Emergency, Maternal Cardiac Arrest.
How to cite this article: Alisaputra AF, Priangga B. Emergency Management of Intraoperative Cardiac Arrest due to Massive Postpartum Hemorrhage: A Case Report of Successful Intraoperative Internal Aortic Compression. Int J Drug Deliv Technol. 2026;16(15s): 398-401. DOI: 10.25258/ijddt.16.15s.47
Source of support: Nil.
Conflict of interest: None