Catastrophic Antiphospholipid Syndrome Presenting as Acute Cardiac Failure During Cesarean Delivery: A Case Report

Abstract

Antiphospholipid syndrome (APS) is a prothrombotic autoimmune disorder. Individuals with triple-positive antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, and anti-β ₂ glycoprotein I) face the greatest risk for complications, especially in obstetric settings, including catastrophic APS (CAPS), a rare but life-threatening condition characterized by rapid multi-organ failure. Although cardiac involvement is uncommon, it may remain clinically silent until acute decompensation occurs. A pregnant patient with established triple-positive APS underwent an elective lower segment cesarean section. She was hemodynamically stable preoperatively and exhibited no evidence of cardiac dysfunction. Shortly after delivery, she experienced sudden hypotension and pulmonary edema, consistent with acute cardiac failure. Prompt intraoperative resuscitation and postoperative intensive care, including anticoagulation, led to complete recovery. This case highlights the potential for sudden intraoperative cardiac collapse in APS patients despite a stable preoperative status. Clinicians should maintain a high index of suspicion for CAPS in cases of acute deterioration and initiate early, aggressive treatment to prevent mortality.