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MedEdPORTAL 2018 10 26;14:10768. Epub 2018 Oct 26.

Perinatal Patient Safety Coordinator, NewYork-Presbyterian Hospital.

Introduction: Cardiac arrest in pregnancy is rare. Advanced Cardiovascular Life Support courses rarely address interventions specific to obstetric patients, and knowledge gaps are frequent among providers. The Society for Obstetric Anesthesia and Perinatology and American Heart Association have published guidelines regarding management of cardiac arrest in pregnancy, and interdisciplinary simulation training has been advocated to reinforce key management points for this clinical scenario. Read More

J Matern Fetal Neonatal Med 2019 Apr 22;32(8):1262-1266. Epub 2017 Nov 22.

a Department of Anesthesia, and Sackler Faculty of Medicine , Rabin Medical Center, Beilinson Hospital, Petach Tikvah Israel, Tel Aviv University , Tel Aviv , Israel.

Introduction: Amniotic fluid embolism (AFE) is a rare and potentially lethal obstetric complication, commonly occurring during labor, delivery, or immediately postpartum. There is a paucity of data regarding incidence, risk factors, and clinical management. Our primary objective in this study was to evaluate clinical presentation of AFE and delineate anesthesia management of these cases. Read More

Acute Med Surg 2017 10 17;4(4):467-471. Epub 2017 Aug 17.

Rinku General Medical Center Senshu Trauma and Critical Care Center Izumisano Osaka Japan.

Cases: Perimortem cesarean delivery (PMCD) is the only way to resuscitate pregnant women in cardiac arrest, and has been found to increase maternal resuscitation rate by increasing circulating plasma volume. However, many obstetricians have not experienced a case of PMCD, as situations requiring it are rare. We report our strategy for cases of maternal cardiac arrest, on the basis of a review of published work, and present two case reports from our medical center. Read More

Ugeskr Laeger 2016 Mar;178(12):V12150959

Perimortem caesarean section can be decisive for the outcome of a cardiac arrest in pregnancy for both mother and fetus. We describe a case story of the management of cardiac arrest in early labour where perimortem caesarean section proved to be life-saving for both mother and child. The child was delivered alive seven minutes after recorded cardiac arrest, and the mother had return of spontaneous circulation one minute after delivery. Read More

J Obstet Gynaecol Can 2015 Jun;37(6):553-74

Saint John, NB.

Objective: Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. The aim of this document is to provide the obstetric care provider with an evidence-based systematic approach to the pregnant trauma patient. Read More

Acta Obstet Gynecol Scand 2014 Oct 27;93(10):965-72. Epub 2014 Aug 27.

Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel.

Cardiopulmonary arrest is a rare event during pregnancy and labor. Perimortem cesarean section has been resorted to as a rare event since ancient times; however, greater awareness regarding this procedure within the medical community has only emerged in the past few decades. Current recommendations for maternal resuscitation include performance of the procedure after five minutes of unsuccessful cardiopulmonary resuscitation. Read More

Can J Anaesth 2013 Nov 14;60(11):1077-84. Epub 2013 Sep 14.

Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada,

Purpose: To review and report maternal and neonatal outcomes after cardiac arrest during pregnancy in a large tertiary care centre and to consider steps to improve the outcomes.

Clinical Features: We performed a retrospective chart review of maternal cardiac arrest in the Mount Sinai Hospital, University of Toronto health records database for the period 1989-2011. Five cases were identified for an incidence of 1:24,883 deliveries (0. Read More

Anesth Analg 2013 Jan 7;116(1):162-7. Epub 2012 Dec 7.

Department of Anesthesia, Stanford University, 300 Pasteur Dr., MC5640, Stanford, CA 94305, USA.

Background: The purpose of this study was to compare cardiopulmonary resuscitation (CPR) for simulated maternal cardiac arrest rendered during transport to the operating room with that rendered while stationary in the labor room. We hypothesized that the quality of CPR would deteriorate during transport.

Methods: Twenty-six teams composed of 2 providers (obstetricians, nurses, or anesthesiologists) were randomized to perform CPR on the Laerdal Resusci Anne SkillReporter™ mannequin during transport or while stationary. Read More

J Perinat Neonatal Nurs 2012 Apr-Jun;26(2):117-23; quiz 124-5

Specialty Obstetrical Referral Clinic and Labor & Delivery, The Medical Center of Plano, Plano, TX 75075, USA.

Cardiac arrest in pregnancy is a rare event, and the speed of resuscitation response is critical to the outcome of both the mother and the fetus. The management of the unresponsive pregnant woman differs from that of the traditional adult resuscitation. In this article, causes of maternal arrest, management of proper cardiopulmonary arrest in pregnancy, and implementation of perimortem cesarean delivery are discussed. Read More

Zhonghua Fu Chan Ke Za Zhi 2011 Oct;46(10):742-7

Department of Obstetrics, Third Affiliated Hospital of Guangzhou Medical College, Guangzhou 510150, China.

Objective: To analyze the cause and clinical characteristics of maternal cardiac arrest.

Methods: The data of all cases of maternal cardiac arrest from January 2005 to December 2009 in Third Affiliated Hospital of Guangzhou Medical College was retrospectively studied.

Results: (1) A total of 41 maternal cardiac arrests (6 in prenatal period, 2 in the first stage of labor, 7 in the third stage of labor, 26 in postpartum period) were included. Read More

J Intensive Care Med 2013 Jul-Aug;28(4):204-14. Epub 2012 Jan 17.

Department of Medicine, University of Alberta, Canada.

Cardiac arrest is a rare occurrence in pregnancy and may be related to obstetric or medical causes. Pregnancy is associated with profound physiologic changes that prepare the gravida for the challenges of labor and delivery, and resuscitation of the pregnant patient needs to take these changes into consideration. Cardiac output and plasma volume increase in pregnancy and distribute differently with the uterine circulation receiving approximately 17% of the total cardiac output. Read More

Obstet Gynecol 2011 Nov;118(5):1090-4

Department of Anesthesia and Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California 94305, USA.

Objective: To compare the labor room and operating room for perimortem cesarean delivery during simulated maternal arrests occurring outside the operating room. We hypothesized transport to the operating room for perimortem cesarean delivery would delay incision and other important resuscitation milestones.

Methods: We randomized 15 teams composed of obstetricians, nurses, anesthesiologists, and neonatal staff to perform perimortem cesarean delivery in the labor room or operating room. Read More

Ned Tijdschr Geneeskd 2010 ;154:A2370

Maasstad Ziekenhuis, locaties Zuider en Clara, Afd. Gynaecologie en Obstetrie, Rotterdam, the Netherlands.

Cardiac arrest is a rare and life-threatening complication during pregnancy. We present the case of a 26-year-old patient in her first pregnancy who during induction of labour at 41 weeks had a cardiac arrest caused by an amniotic fluid embolism. As part of the resuscitation procedure, a perimortem caesarean section was performed in the delivery room within five minutes. Read More

Can J Anaesth 2004 Jun-Jul;51(6):586-609

Department of Anesthesia, University of Manitoba, Winnipeg, Manitoba, Canada.

Purpose: To review the effects of maternal anesthesia and analgesia on the fetus and newborn.

Methods: An on-line computerized search of Medline, Embase, and the Cochrane Collaboration via PubMed was conducted. English language articles were selected. Read More

Emerg Med Clin North Am 2003 Aug;21(3):679-93

Department of Emergency Medicine, Health Science Center, Texas A&M University System, Temple, TX, USA.

The emergency department is a suboptimal location for delivery, and the greater prevalence of complicated presentations and emergency deliveries results in higher morbidity and mortality. Any woman greater than 20 weeks' gestation in labor is considered medically unstable and should be triaged quickly. Fetal viability occurs after 24 to 26 weeks' gestation. Read More

Emerg Med Clin North Am 1994 Feb;12(1):201-17

Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois.

The care of the pregnant patient presenting to the emergency department with labor or delivery complications requires an understanding of signs and symptoms of disease for the maternal and fetal patient. This article reviews management of common labor and delivery complications that may occur in the emergency department. The management of premature labor, premature rupture of the membranes, emergency delivery procedure, resolution of shoulder dystocia, prolapsed umbilical cord, and perimortem cesarean section are discussed. Read More

Emerg Med Clin North Am 1987 Aug;5(3):529-40

Harbor/UCLA Medical Center, Torrance.

The incidence of high-risk conditions complicating pregnancy is greater than one would suspect. Many times a pregnancy does not become high risk until labor starts. Prehospital and Emergency Department protocol should be directed at getting the mother to the labor and delivery suite as soon as possible. Read More