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:
- 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.
- 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.
- 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.
- 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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