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Cureus 2021 Mar 27;13(3):e14148. Epub 2021 Mar 27.

Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.

Cardiac arrest in pregnancy is an uncommon encounter, with the incidence being one in every 12,000 hospital admissions for delivery. Here we present, one such patient and our experience in managing the patient. A 23-year-old, third-trimester pregnant female presented with a history of polytrauma following a road traffic accident. Read More

Perfusion 2021 Mar 19:2676591211003281. Epub 2021 Mar 19.

Division of Cardiothoracic Surgery, Department of Surgery, Khon Kaen hospital, Khon Kaen, Thailand.

Introduction: Maternal cardiac arrest is a rare condition. Cardiopulmonary resuscitation (CPR) in pregnancy is different from that in other populations due to physiological changes in patients. Extracorporeal cardiopulmonary resuscitation (ECPR) is recommended in patients having cardiac arrest with potentially reversible etiologies. Read More

Am J Obstet Gynecol 2021 04 6;224(4):B29-B32. Epub 2021 Jan 6.

Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.

Amniotic fluid embolism is a rare syndrome characterized by sudden cardiorespiratory collapse during labor or soon after delivery. Because of its rarity, many obstetrical providers have no experience in managing amniotic fluid embolism and may therefore benefit from a cognitive aid such as a checklist. We present a sample checklist for the initial management of amniotic fluid embolism based on standard management guidelines. Read More

Clin Pract Cases Emerg Med 2020 Nov;4(4):623-625

Loma Linda University, Department of Emergency Medicine, Loma Linda, California.

Introduction: Uterine ruptures in blunt trauma are an extremely rare complication. Furthermore, while perimortem cesarean sections in cardiac arrest patients are a well-established practice in emergency medicine, cesarean sections in the emergency department are rarely performed on non-arresting patients.

Case Report: A multigravida woman at approximately 24 weeks gestation presented as a transfer from an outside hospital after a motor vehicle collision. Read More

Cureus 2020 Sep 22;12(9):e10588. Epub 2020 Sep 22.

Emergency Medicine, Memorial University of Newfoundland, St. John's, CAN.

Simulation-based medical education (SBME) is an educational technique that enables participants to experience an immersive representation of a clinical event for the purpose of practice, learning, and evaluation. This experience is intended to improve trainees' competency and confidence in both procedural tasks, as well as team-based and interpersonal skills when responding to real-world clinical encounters. Moreover, SBME improves procedural exposure and competency in low-frequency, high-stakes clinical procedures without the risk of adverse consequences, error, or patient harm - a priority for physician training at all levels. Read More

Emerg Med Pract 2020 10 15;22(Suppl 10):1-36. Epub 2020 Oct 15.

Lee Physician Group, Fort Myers, FL.

This supplement reviews the evidence regarding important considerations in pregnant trauma patients, including the primary and secondary survey as well as the possibility for Rh exposure, placental abruption, uterine rupture, and the need for a prompt perimortem cesarean section in the moribund patient. Because ionizing radiation is a concern in pregnancy, the circumstances in which benefits of testing outweigh risks to the fetus are discussed. Emergency clinicians are encouraged to advocate for trauma prevention, including proper use of safety restraints in motor vehicles and screening for domestic violence, as these measures have been shown to be effective in reducing morbidity and mortality in this patient population. Read More

Emerg Med Clin North Am 2020 Nov;38(4):903-917

Department of Internal Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. Electronic address: https://twitter.com/hong_aleta.

Care of the critically ill pregnant patient is anxiety-provoking for those unprepared, as the emergency physician must consider not only the welfare of the immediate patient, but of the fetus as well. Familiarity with the physiologic changes of pregnancy and how they affect clinical presentation and management is key. Although some medications may be safer in pregnancy than others, stabilizing the pregnant patient is paramount. Read More

Z Geburtshilfe Neonatol 2020 Apr 20;224(2):61-70. Epub 2020 Apr 20.

Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein.

Collapse and sudden cardiac arrest (SCA) threaten people of all sexes. Although their incidence positively correlates with age, even pregnant women can (rarely) be affected by such cardiovascular emergencies. Transient alterations in maternal circulation caused by vena cava compression syndrome and collapse are to be distinguished from SCA. Read More

Eur Rev Med Pharmacol Sci 2020 03;24(6):2795-2801

Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy.

Objective: Every year 0.5-2% of women undergo non-obstetric surgery in pregnancy. Hypoxic events with short-term and long-term consequences are one of the most frequent complications in surgery. Read More

Taiwan J Obstet Gynecol 2020 01;59(1):170

Department of Obstetrics and Gynecology, Ningbo First Hospital, Ningbo, Zhejiang, China.

Prehosp Emerg Care 2020 Jul-Aug;24(4):595-599. Epub 2019 Oct 11.

Cardiac arrest in pregnancy is rare. It has a reported incidence of approximately 1 in 30000 pregnancies worldwide and occurs prehospitally with rates of around 3 in every 100000 live births within the developed world. The management of maternal cardiac arrest is complicated by the anatomical and physiological changes of pregnancy, its rarity and clinician unfamiliarity. Read More

Ann Emerg Med 2019 12 9;74(6):772-774. Epub 2019 May 9.

Department of Emergency Medicine, Michigan Medicine, Ann Arbor, MI.

Cardiac arrest and resuscitation of the pregnant woman at gestational term is rare. Depending on the circumstances of cardiac arrest and its timing, options are limited for allowing successful resuscitation of both mother and neonate. Herein, we describe the use of tandem perimortem cesarean section and thoracotomy for open-chest cardiac massage in a young woman with newly diagnosed peripartum cardiomyopathy. Read More

Emerg Med Clin North Am 2019 May 8;37(2):351-363. Epub 2019 Mar 8.

Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University School of Medicine, 110 Irving Street Northwest, Suite 4B-42, Washington, DC 20010, USA. Electronic address:

Many health care providers lack familiarity with maternal physiologic changes and the distinctive underlying etiology of cardiac arrest in pregnancy. Knowledge of what changes are expected in pregnancy and an understanding of how to adapt clinical practice is essential for the care of the pregnant woman in the emergency department. Amniotic fluid embolism should be recognized as a rare cause of cardiac arrest in pregnancy, characterized by the triad of cardiovascular collapse, hypoxic respiratory failure, and coagulopathy. Read More

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

Taiwan J Obstet Gynecol 2019 Jan;58(1):43-45

Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan. Electronic address:

Objective: The aim of this study is to share a valuable experience of perimortem Cesarean delivery (PMCD) when no signs of spontaneous circulation were detected after 4 min of resuscitation. The time interval between maternal cardiac arrest and neonatal delivery was evaluated and reviewed.

Case Report: We present the case of an out-of-hospital cardiac arrest (OHCA) in a nulliparous woman who survived a car accident with only seatbelt injuries. Read More

Resuscitation 2019 02 30;135:224-225. Epub 2018 Dec 30.

University College London & University College Hospital, EGA Wing, 25 Grafton Way, London WC1E 6DB, United Kingdom. Electronic address:

J Obstet Gynaecol Res 2019 Mar 22;45(3):724-728. Epub 2018 Nov 22.

Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Japan.

Resuscitative hysterotomy (RH) is a resuscitation technique, allowing the restoration of a pregnant patient's heartbeat. Here, we reported a case of RH performed in a patient with cardiac arrest as a complication of a peripartum cardiomyopathy. A 29-year-old woman with suspected hemolysis, elevated liver enzymes, low platelet syndrome was admitted to the hospital. Read More

J Obstet Gynaecol Res 2019 Feb 25;45(2):325-330. Epub 2018 Sep 25.

Department of Maternal and Fetal Medicine, Miyagi Children's Hospital, Sendai, Japan.

Aim: Perimortem cesarean section (PCS) is a procedure performed as part of cardiopulmonary resuscitation (CPR). This study aims to clarify maternal and neonatal prognosis and establish PCS's utility and limitations.

Methods: We sent structured questionnaires to obstetrics facilities regarding the cases of PCS performed in Japan between April 2010 and April 2015. Read More

J Matern Fetal Neonatal Med 2020 Apr 23;33(8):1456-1458. Epub 2018 Sep 23.

Department of Maternal-Neonatal Care, DAIMI, Careggi University Hospital, Florence, Italy.

Cardiac arrest in pregnancy is a rare event due to different cause. When it occurs after spinal anesthesia a cause that can explain this event is the Bezold-Jarish Reflex (BJR). A cardiac arrest occurs in a pregnant women after spinal anesthesia admistered for urgent caesarean section. Read More

Curr Treat Options Cardiovasc Med 2018 Jun 19;20(7):57. Epub 2018 Jun 19.

Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, USA.

Purpose Of Review: The goal of this review is to elucidate what is known about the science of maternal resuscitation and how treatment guidelines have developed to optimize management.

Recent Findings: There is limited data on maternal cardiac arrest. Case reports are providing some insight into safety and efficacy of certain mechanisms of treatment, including use of extracorporeal membranous oxygenation and thrombolysis, for example. Read More

J Obstet Gynaecol India 2018 Jun 26;68(3):155-163. Epub 2018 Mar 26.

2Department of Anaesthesiology, Pain & Critical Care, AFMC, Pune, India.

Maternal mortality is disastrous news for the society, family, newborn, and the obstetrician. Yet, we all who are care providers to these apparently healthy women carrying another life within them are dumbfounded by the clinical conditions arising due to the pregnancy or the effects of the pregnancy, that it becomes difficult to provide an ideal care to them. The rapid uprising of a condition and the worsening of commonly occurring benign conditions-preeclampsia, hemorrhage, etc. Read More

Am J Obstet Gynecol 2018 07 2;219(1):52-61. Epub 2018 Jan 2.

Southern Colorado Maternal Fetal Medicine, Colorado Springs, CO.

While global maternal mortality has decreased in the last 25 years, the maternal mortality ratio in the United States has actually increased. Maternal mortality is a complex phenomenon involving multifaceted socioeconomic and clinical parameters including inequalities in access to health care, racial and ethnic disparities, maternal comorbidities, and epidemiologic ascertainment bias. Escalating maternal mortality underscores the importance of clinician preparedness to respond to maternal cardiac arrest that may occur in any maternal health care setting. Read More

Semin Perinatol 2018 02 13;42(1):33-38. Epub 2017 Dec 13.

Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814. Electronic address:

Cardiac arrest in pregnancy is a rare and frightening event. Although not every obstetrician will encounter cardiac arrest in pregnancy during their career, it is imperative to be prepared to manage this acute emergency. The management is particularly complex due to maternal physiologic changes from pregnancy and the simultaneous management of two patients, the mother and fetus. 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

Isr Med Assoc J 2017 09;19(9):586-589

Department of Jewish History, Ben-Gurion University of the Negev, Beer Sheva, Israel.

Background: Maternal cardiac arrest during gestation constitutes a devastating event. Training and anticipant preparedness for prompt action in such cases may save the lives of both the woman and her fetus.

Objectives: To address a previous Jewish guideline that a woman in advanced pregnancy should not undergo any medical procedure to save the fetus until her condition is stabilized. Read More

Emerg Med J 2017 May 7;34(5):326-330. Epub 2017 Mar 7.

Academic Department of Clinical Traumatology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

The need for prehospital resuscitative hysterotomy/perimortem caesarean section is rare. The procedures can be daunting and clinically challenging for practitioners. Maternal death can be averted by swift and decisive action. Read More

BJOG 2017 Aug 24;124(9):1374-1381. Epub 2017 Feb 24.

University Hospitals of Leicester NHS Trust, Leicester, UK.

Objective: To describe the incidence, risks, management and outcomes of cardiac arrest in pregnancy in the UK population, with specific focus on the use of perimortem caesarean section (PMCS).

Design: A prospective, descriptive study using the UK Obstetric Surveillance System (UKOSS).

Setting: All UK hospitals with maternity units. Read More