Severe Respiratory Failure After Elective Repeat Cesarean Delivery: A Potentially Preventable Condition Leading to Extracorporeal Membrane Oxygenation

Abstract

Significant respiratory morbidity following elective cesarean delivery has been widely reported.1-4 More recently, it has been recognized that this morbidity is not always the result of inadvertent delivery of a premature neonate,5 but, instead, may be due to a predilection of these neonates for developing persistent pulmonary hypertension of the newborn(PPHN).6-8 Despite Heritage and Cunningham's report6 of 25% mortality in patients with persistent pulmonary hypertension following elective repeat cesarean section, the potential severity of respiratory distress associated with this method of delivery does not appear to be generally recognized. Extracorporeal membrane oxygenation (ECMO) is increasingly used to treat newborns