1. MATERNAL CARDIAC ARREST (MCA), EMERGENCY RESPONSE & PERIMORTEM CESAREAN SECTION (PMSC)
Asma Ansari 1, Shehla Baqai 2
1 Armed Forces Institute of Cardiology & National Institute of Heart Diseases 2 Army Medical College, Military Hospital Rawalpindi
INTRODUCTION
METHODOLOGY
RESULTS
Total number of patients n = 15
100% patients received ACLS
Place of MCS was labor room for 5 (33%) patients
Apparent cause of MCA amniotic fluid embolism 7(46%)
Maternal mortality 73.3%, Neonatal mortality 64.3%
Timings of PCMS is strongly associated with survival
Maternal Cardiac Arrest is the most complex arrest scenario, as there are two patients mother and fetus
MCA is rare, reportedly occurring in 1 in 30,000 pregnancies
Current American Heart Association and Royal College of Gynaecologists guidelines recommend slight modifications
Most important modification is PMCS within in 5 minutes of MCA to facilitate maternal resuscitation in gestation of > 20 weeks of pregnancy
Retrospective analysis of hospital records from Jan 2010 to Dec 2015
Inclusion Criteria: All pregnant patients diagnosed with cardiac arrest treated with chest compressions and provision of ACLS and PMCS
Exclusion Criteria: Patients < 20 weeks gestation, out of hospital cardiac arrest and maternal return of spontaneous circulation within 4 minutes
Chi square test was applied to find association between groups
CONCLUSION
RESULTS
Best hope of fetal survival is maternal survival
Maternal resuscitation training should be given to all Health Care Professionals
Early recognition, immediate CPR with recourse to PMCS within 5 minutes saves lives
Table 1: Maternal characteristics of study population
Characteristics (Mean ± SD)
Values 1
Mean Age
34.4 ± 5.2 years 2
Mean gestational age
35.33 ± 2.02 weeks 3
Mean interval before PMCS
19.07 ± 6.1 minutes
FUTURE IMPLICATIONS
First case series reported in Pakistan
All emergency departments and Obstetric units to keep required data for further prospective studies.
Resuscitation guidelines and PMCS equipment available at ER and labor room
Figure 2: Maternal and neonatal survival after PMCS
Figure 1:
American Heart Association guidelines for MCA
REFERENCES
OBJECTIVES
2010 American Heart Association guidelines for CPR and Emergency cardiovascular care.
RCOG. Maternal collapse in pregnancy and Puerperium. Green Top guidelines no
Einav S et al. Maternal cardiac arrest and perimortem caesarean delivery: evidence or expert-based?. Resuscitation Oct 31;83(10):
To determine outcome of MCA
To establish association of PMCS timing with maternal & neonatal survival