Wed3November0844PM 14

A 32-year-old parturient at 40 weeks gestation has a cardiac arrest on the labour ward.

Which one of the following statements is the most appropriate regarding maternal resuscitation?

(Please select 1 option)

Commence advanced cardiac life support with 30 degree right lateral tilt to avoid aortocaval compression

If there is no return of spontaneous circulation after four minutes of resuscitation a caesarean section should be performed Correct

Commence advanced cardiac life support in the left lateral position with cricoid pressure as there is a risk of aspiration

Intravenous access is best established inferior to the diaphragm

Immediate emergency perimortem caesarean section followed by advanced cardiac life support because the baby's life is paramount

Explanation

Nearly one in four cardiac arrests in pregnancy are associated with complications of obstetric anaesthesia

Maternal cardiac arrest is rare with an incidence of 1 in 36,000 with maternal survival rates of 58%. The key to survival is timely resuscitation and prompt perimortum caesarean section. In this study 24% of the patients had a cardiac arrest associated with obstetric anaesthesia (epidural, spinal or spinal epidural), of these patients 12 of 15 were obese.

Other associations and causes of cardiac arrest were:

Hypovolaemia

Venous thromboembolism (clot or amniotic fluid)

The haemodynamics should be optimised during maternal cardiac arrest in the clearly pregnant patient. This includes intravenous access above the diaphragm and effective aortocaval decompression. The most ideal manner to perform aortocaval decompression is with a manual left uterine displacement (LUD). A perimortum caesarean section (PMCS) should be performed if there is no return of spontaneous circulation (ROSC) by 4 minutes with the usual resuscitation measures. The mother's life is of paramount importance.

Reference:

The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study.

Beckett VA1, Knight M2, Sharpe P3. BJOG. 2017 Aug;124(9):1374-1381. doi: 10.1111/1471-0528.14521.

Cardiac Arrest in Pregnancy. A statement from the American Heart Association. Jeejeebhoy F.M et al. Circulation. 2015; 132:1747 - 1773.

Answer Statistics

1

14%

2

68%

3

15%

4

5%

Times answered: 344