60 - Resuscitation of the pregnant patient suffering sudden cardiac death

Summary

Clinical scenario: A 20-year-old pregnant woman is admitted to the emergency room having had a cardiac arrest at home. Cardiac massage and intubation had been performed at home with the patient in the left lateral position. An emergency Cesarean section takes place on the emergency room trolley in “not particularly aseptic conditions”, and a live infant is born. The mother 's cardiovascular system now responds to resuscitative measures. Three weeks later, after a stormy period in the intensive care unit, she is discharged to the ward with a left hemiparesis. Eighteen years later she sees her son get a place at university.

Introduction

Pregnancy places considerable stress on the cardiorespiratory system. Despite this, cardiac arrest is uncommon – Willis and Rees estimated it to occur once in approximately 30000 late deliveries, but survival from such an event is exceptional. The United Kingdom 's Confidential Enquiry into Maternal and Child Health (CEMACH), formerly known as the Confidential Enquiry into Maternal Deaths, reports that most maternal deaths are from acute causes, with many mothers receiving some form of resuscitation. Nevertheless, the number of indirect deaths (deaths from medical conditions exacerbated by pregnancy) is greater than that of deaths from conditions that arise from pregnancy itself. These indirect deaths seem to be increasing as a result of both social trends and medical progress. The advance of surgical procedures and medical treatments has meant that women who previously would not have survived to adulthood may now reach pregnancy.