Abstract
Cardiac arrest (CA) in pregnancy is an uncommon occurrence with an incidence of about 1 in every 30,000 deliveries (1). The causes are quite numerous, but the management is essentially the same with the exception of a few modifications regarding the fetus. In this chapter, causes of maternal mortality are reviewed along with potential interventions to decrease its incidence. A general overview of maternal and fetal physiology and how it pertains to the resuscitation of the mother will also be provided. Pharmacological agents used in the resuscitative protocol and their effects on the fetus are discussed. Finally, the issue of perimortem cesarean delivery is addressed, along with the difficult questions that must be answered within minutes of deciding who should and should not be considered for this drastic, potentially lifesaving procedure.
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References
Takouri MSM, Seraj MA, Channa AB. Advisory Statement of the International Liaison Committee on Resuscitation (ILCOR). CPR in pregnancy. Middle East J of Anesth 1998;14:399–405.
Differences in maternal mortality among black and white women—United States, 1990. MMWR 1995;44:6,7,13,14.
Berg CJ, Atrash HK, Koonin LM, Tucker M. Pregnancy-related mortality in the United States, 1987–1990. Ob Gyn 1996;88:162–167.
Maternal mortality—United Stated, 1982–1996. MMWR 1998;47:705–707.
Koonin LM, MacKay AP, Berg CJ, Atrash HK, Smith JC. Pregnancy-related mortality surveillance-United States, 1987–1990. MMWR 1997;46:17–36.
State-specific maternal mortality among black and white women—United States, 1987–1996. MMWR 1999;48:492–496.
Kaunitz AM, Hughes JM, Grimes DA, et al. Causes of maternal mortality in the United States. Ob Gyn 1985;65:605–612.
Rochat RW, Koonin LM, Atrash HK, Jewett JF. Maternal mortality in the United States: Report from the Maternal Mortality Collaborative. Ob Gyn 1988;72:91–97.
Jacob S, Bloebaum L, Shah G, Varner MW. Maternal mortality in Utah. Ob Gyn 1998;91:187–191.
Atrash HK, Alexander S, Berg CJ. Maternal mortality in developed countries: Not just a concern of the past. Ob Gyn 1995;86:700–705.
Ghosh MK. Maternal mortality: A global perspective. J Reprod Med 2001;46:427–433.
Goodburn E, Campbell O. Reducing maternal mortality in the developing world: Sector-wide approaches may be the key. Br Med J 2001;322:917–920.
Opportunities to reduce maternal and infant mortality. MMWR 1999;48:856.
Ueland K. Maternal cardiovascular dynamics. VII. Intrapartum blood volume changes. Am J Ob Gyn 1976;126:671–677.
Gibbs CP. Maternal physiology. Clin Ob Gyn 1981;24:525–543.
Pritchard JA. Changes in blood volume during pregnancy and delivery. Anesthesiology 1965;26:393–399.
Ueland K, Novy MJ, Peterson EN, Metcalfe J. Maternal cardiovascular dynamics. IV. The influence of gestational age on the maternal cardiovascular response to posture and exercise. Am J Ob Gyn 1969;104:856–864.
Ueland K, Metcalfe J. Circulatory changes in pregnancy. Clin Ob Gyn 1975;18:41–50.
Veille JC, Morton MJ, Burry KJ. Maternal cardiovascular adaptations to twin pregnancy. Am J Ob Gyn 1985;153:261–263.
Clark SL, Cotton DB, Lee W, Bishop C, et al. Central hemodynamic assessment of normal term pregnancy. Am J Ob Gyn 1989;161:1439–1442.
Cugell DW, Frank NR, Gaensler ED, et al. Pulmonary function in pregnancy: I. Serial observations in normal women. Am Rev Tuberc 1953;67:568–597.
Awe RJ, Nicotra MB, Newson TD, Viles R. Arterial oxygenation and alveolar-arterial gradients in term pregnancy. Ob Gyn 1979;53:182–186.
Archer GW, Marx GF. Arterial oxygen tension during apnea in parturient women. Br J Anesth 1974;46:358–360.
Dinnick OP. Hiatus hernia: An anesthetic hazard. Lancet 1961;1:400–473.
Macfie AG, Magides AD, Richmond MN, Reilly CS. Gastric emptying in pregnancy. Br J Anesth 1991;67:54–57.
Attia RR, Ebeid AM, Fischer JE. Gastrin: Placental, maternal, and plasma cord levels: Its possible role in maternal residual gastric acidity (abstract). American Society of Anesthesiologists Annual Meeting. 1976:547.
Roberts RB, Shirly MA. Reducing the risks of acid aspiration during cesarean section. Anesth Analg 1974;53:859–868.
Sellick BA. Cricoid pressure to control regurgitation of stomach contents during induction of anesthesia. Lancet 1961;2:404–406.
Metcalfe J, Romney SL, Ramsey LH, et al. Estimation of uterine blood flow in normal human pregnancy at term. J Clin Invest 1955;34:1632–1643.
Kerr MG. The mechanical effects of the gravid uterus in late pregnancy. J Ob Gyn Br Commonw 1965:513.
Kauppila A, Koskiner M, Puolakka J, et al. Decreased intervillous and unchanged myometrial flow in supine recumbency. Ob Gyn 1980;55:203–205.
Koffler H. Fetal and neonatal physiology. Clin Ob Gyn 1981;24:545–553.
Rudolph AM, Heymann MA. The fetal circulation. Ann Rev of Med 1968;19:195–206.
Bunn HF, Jandl JH. Control of fetal hemoglobin function within the red cell. NEJM 1970;282:1414–1420.
Rulolph AM. The fetal circulation and its response to stress. J Dev Physiol 1984;6:11–19.
Gimovsky ML. Fetal heart rate monitoring. Casebook: Fetal heart rate monitoring during respiratory and cardiac arrest. J Perinat 1997;17:495–499.
Clark SL, Hankins GD, Dudley DA, et al. Amniotic fluid embolism: Analysis of the national registry. Am J Ob Gyn 1995;172:1158–1169.
Kloeck W, Cummings RD, Chamberlain D, et al. Special resuscitative situations: An advisory statement from the International Liaison Committee on Resuscitation. Circul 1997;95:2196–2210.
Tsui BC, Stewart B, Fitzmaurice A, Williams R. Cardiac arrest and myocardial infarction induced by postpartum intravenous ergonovine administration. Anesthesiology 2001;94:363–364.
Thrush DN, Downs JB. Vagotonia and cardiac arrest during spinal anesthesia. Anesthesiology 1999;91:1171–1173.
Curry JL, Quintana FJ. Myocardial infarction with ventricular fibrillation during pregnancy treated by direct current with fetal survival. Chest 1970;58:82–84.
Lopez-Zeno JA, Carlo WA, O’Grady JP, Fanaroff AA. Infant survival following delayed postmortem cesarean delivery. Ob Gyn 1990;76:991–992.
Datta S, Nasr NF, Khorasani A, Datta R. Current concepts in cardiopulmonary resuscitation in adults. J Indian Med Assoc 1999;97:259–264.
Lee RV, Rodgers BD, White LM, Harvey RC. Cardiopulmonary resuscitation of pregnant women. Am J Med 1986;81:311–318.
Dildy GA, Clark SL. Cardiac arrest during pregnancy. Ob Gyn Clin N Amer 1995;22:303–314.
Katz VL, Dotters DJ, Droegemueller W. Perimortem cesarean delivery. Ob Gyn 1986;68:571–576.
Plum F. Vulnerability of the brain and heart after cardiac arrest. NEJM 1991;324:1278–1280.
Cummings RO (ed.): Advanced Cardiac Life Support Provider Manual, 5th ed. Dallas: American Heart Association, 2001.
Satin AJ, Hankins GDV. Cardiopulmonary resuscitation in pregnancy. In: Critical Care Obstetrics, 2nd ed. Clark SL, Cotton DB, Hankins GDV, et al, eds. Boston: Blackwell Scientific, 1991:579–598.
Whitten M, Irvine LM. Postmortem and perimortem cesarean section: what are the indications? J Royal Soc of Med 2000;93:6–9.
Anonymous. Part 8: Advanced challenges in resuscitation. Section 3: Special challenges in ECC. 3F: Cardiac arrest associated with pregnancy. Resuscitation 2000;46:293–295.
Behmey CA. Cesarean section delivery after death of the mother. JAMA 1961;176:617–619.
Weber CE. Postmortem cesarean section: Review of the literature and case reports. Am J Ob Gyn 1971;110:158–163.
Lemons JA, Korones SB, Papile LA, Stoll BJ, et al. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 through December 1996. NICHD Research Network. Pediatrics 2001;107:E1.
Depp R, Lemons JA. Perinatal care at the threshold of viability. American College of Obstetricians and Gynecologists Practice Bulletin 2002;100:617–624.
Hadlock FP. Sonographic estimation of fetal age and weight. Radiologic Clin of N Amer 1990;28:39–50.
Weber CE. Postmortem cesarean section: Review of the literature and case reports. Am J Ob Gyn 1971;110:158–163
Hadlock FP, Deter RL, Harrist RB, et al. Fetal biparietal diameter: A critical reevaluation of the relation to menstrual age by means of real time ultrasound. J Ultrasound Med 1982;1:97–104.
Kam CW. Perimortem cesarean sections. J Accident Emerg Med 1994;11:57–58.
Chen HF, Chien NL, Huang GD, et al. Delayed maternal death after perimortem cesarean section. Acta Ob Gyn Scand 1994;73:839–841.
Cardosi RJ, Porter KB. Cesarean delivery of twins during maternal cardiopulmonary arrest. Ob Gyn 1998;92:695–697.
Parker J, Balis N, Chester S., et al. Cardiopulmonary arrest in pregnancy: Successful resuscitation of mother and infant following immediate cesarean section in labour ward. Aust NZ J Ob Gyn 1996; 36:207–210.
DePace NL, Betesh JS, Kotler MN. Postmortem cesarean section with recovery of both mother and offspring. JAMA 1982;248:971–973.
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Rodriguez, A.A., Dildy, G.A. (2005). Cardiac Arrest in Pregnancy. In: Ornato, J.P., Peberdy, M.A. (eds) Cardiopulmonary Resuscitation. Contemporary Cardiology. Humana Press. https://doi.org/10.1385/1-59259-814-5:395
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DOI: https://doi.org/10.1385/1-59259-814-5:395
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