AHA Statement on Cardiac Arrest in Pregnancy

Jeejeebhoy FM, Zelop CM, Lipman S, et al.
Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association. Circulation 2015;132:1747-1773.

The following are key points to remember from this American Heart Association Scientific Statement on cardiac arrest in pregnancy:

  1. Maternal mortality is defined as the death of a woman during pregnancy and up to 42 days after delivery or termination of pregnancy. US data suggest that cardiac arrest occurs in 1:12,000 admissions for delivery. Per the Centers for Disease Control and Prevention, death among pregnant women has increased since 1989. A maternal near miss is defined as a woman who nearly dies during pregnancy, childbirth, or <42 weeks post-pregnancy. Survival after maternal cardiac arrest can be over 50%; however, understanding management in the pregnant women is important.
  2. Resuscitation for pregnant women is in large part similar to standard adult resuscitation; however, physiologic effects of pregnancy require modification of resuscitation efforts. Increases in maternal blood volume and reduced pulmonary functional residual capacity are some of the physiologic changes occurring with pregnancy.
  3. If cardiopulmonary resuscitation is initiated, including chest compression performed at a rate of at least 100 per minute with interruptions kept to a minimum, the mother should be in the supine position with manual left uterine displacement to reduce compression of the inferior vena cava and aorta, thus improving circulation.
  4. Immediate cesarean delivery should be anticipated, performed at the site of the arrest, preferably within 5 minutes of arrest. Hospitals should have teams with predeveloped management plans in place, including adult resuscitation, obstetrics, anesthesia, and neonatology.

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