Abstract

A 34-year old gravida 5, para 1 ⁺³ (none alive), presented with an 8-hour history of labour at 36 weeks gestation. On examination, she was grossly obese (BMI 43), had a pulse rate of 92 bpm, blood pressure of 100/70 mmHg and bilateral pedal oedema. She had a singleton fetus, lying transverse. Emergency Caesarean section was planned. In the operating theatre, she had spinal (subarachnoid) blockade with a 25-G Whitacre spinal needle and 2.2 ml of 0.5 % hyperbaric bupivacaine. Shortly thereafter, she complained of a progressively worsening respiratory difficulty, for which she was intubated and ventilated. Large amounts of blood –stained frothy fluid poured out of the pharynx at laryngoscopy, and from the endotrachial tube after intubation. She had cardiac arrest, and all resuscitative efforts failed. At autopsy, she was found to also have dilated cardiomyopathy, which was not diagnosed premortem.

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