• Br J Anaesth · Sep 2009

    Case Reports

    Cardiopulmonary arrest in pregnancy: two case reports of successful outcomes in association with perimortem Caesarean delivery.

    McDonnell highlights the differences in managing the collapsed parturient, namely:

    • Need to prevent aortocaval compression.
    • Early securing of the airway.
    • Rapid perimortem Caesarean delivery.
    • Likelihood of a non-cardiac/pregnancy cause.

    The two cases presented include arrest due to ruptured uterus and arrest possibly due to iatrogenic magnesium overdose. Both resulted in favorable, though not perfect, outcomes for mother and baby.

    The need for delivery suite ‘perimortem cesarean section packs’ is also discussed, as well as the use of regular simulation training.

    summary
    • N J McDonnell.
    • Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, 374 Bagot Road, Subiaco, Western Australia 6008, Australia. nolan.mcdonnell@health.wa.gov.au
    • Br J Anaesth. 2009 Sep 1;103(3):406-9.

    AbstractCardiac arrest in pregnancy is a rare event in which the speed of the response and attention to a number of pregnancy-specific interventions is crucial to the outcome. The commencement of a perimortem Caesarean delivery within 4 min of the onset of the arrest has been recommended as a technique to potentially improve survival in both the mother and the fetus but presents significant logistical challenges to the health-care facility. In this report, we describe two cases of cardiac arrest in pregnancy in which a perimortem Caesarean was performed as part of the resuscitation process and was associated with excellent maternal and neonatal outcomes. We discuss some of the issues surrounding the performance of a perimortem Caesarean delivery that were relevant to this case, including experience from the training that is provided in our institution.

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    This article appears in the collection: The evidence for perimortem caesarean section.

    Notes

    summary
    1

    McDonnell highlights the differences in managing the collapsed parturient, namely:

    • Need to prevent aortocaval compression.
    • Early securing of the airway.
    • Rapid perimortem Caesarean delivery.
    • Likelihood of a non-cardiac/pregnancy cause.

    The two cases presented include arrest due to ruptured uterus and arrest possibly due to iatrogenic magnesium overdose. Both resulted in favorable, though not perfect, outcomes for mother and baby.

    The need for delivery suite ‘perimortem cesarean section packs’ is also discussed, as well as the use of regular simulation training.

    Daniel Jolley  Daniel Jolley
    summary
    0

    McDonnell makes a concerning observation regarding the ageing maternity population and subsequent potential for increasing rates of maternal arrest:

    With the change in the obstetric population characteristic to women being older, heavier, and having more complex medical problems during pregnancy, the number of women who become seriously unwell while pregnant is likely to increase.

    Daniel Jolley  Daniel Jolley
     
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