Cardiopulmonary resuscitation in pregnancy cardiac arrest and perimortem cesarean delivery

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Patchareya Nivatpumin


Background: Pregnancy cardiac arrest is a rare
condition leading to a high maternal and neonatal
mortality rate. Wide ranges of etiologies of cardiac
arrest in pregnancy have been reported in the historical
literature, including postpartum hemorrhage, amniotic
fluid embolism, cardiovascular diseases and anesthetic
causes. Certain resuscitation strategies are used for
pregnancy cardiac arrest which diverge from the
normal population; they are anticipation of difficult
airway management, intravenous line approach above
the diaphragm, manual left uterine displacement,
and consideration of perimortem cesarean delivery
(PMCD) within 4 minutes if the return of spontaneous
circulation is not achieved. It has been acknowledged
that PMCD increases the chance of survival of both
the patient and the neonate since PMCD alters the
pregnancy physiology. A reduction of the uterine
volume resulting from PMCD brings about an
improvement in the blood flow back to the central
circulation by relieving the aortocaval compression;
a lessening of oxygen consumption; and an increase
in the lung expansion, thereby improving lung
compliance. The author reviewed up-to-date
guidelines for resuscitation in the event of pregnancy
cardiac arrest and PMCD in order to provide
knowledge to all readers. The author hopes that
what readers learn can save two lives, that of the
mother and her baby, in the future.

Article Details

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