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INTRODUCTION

KEY QUESTIONS

  • What are the most common causes of death in the obstetric population, and what are the trends in maternal mortality statistics?

  • What are the physiologic changes in pregnancy that play key roles in cardiopulmonary resuscitation (CPR)?

  • How is CPR different in the pregnant population?

  • How do you decide when to proceed with a perimortem cesarean delivery (PMCD)?

  • What are the common pitfalls surrounding the decision to proceed with PMCD?

CASE 38-1

A 38 y.o. G3P2002 at 38 and 4/7 weeks gestation admitted to the hospital in early labor began complaining of shortness of breath, then developed sudden-onset mental status changes and eventual loss of consciousness. The nurse at the bedside called the MD, who immediately came and noted the patient to be pulseless and not breathing. Code Blue was activated, and chest compressions began.

Maternal death is a rare complication of pregnancy. Despite this fact, pregnancy-related mortality in the United States is increasing as women delay childbearing into their third and fourth decades of life. Pregnancy at advanced maternal ages unmasks underlying medical problems, and maternal heart disease is currently the main cause of death.

Once the diagnosis of maternal Code Blue is made in an unresponsive pregnant woman, acute intervention with CPR and Basic Life Support (BLS) can help maintain maternal circulation while preparing to perform a potentially lifesaving PCMD. Despite the data on poor maternal survival rates after a PCMD, the potential benefits to the fetus make this procedure indicated.

This chapter will explore the epidemiology of maternal mortality in the United States, followed by a discussion about the physiologic changes of pregnancy that result in the necessary changes for effective CPR in the pregnant population. The discussion will conclude with an in-depth discussion on the issues surrounding the PMCD and ways to maximize fetal and maternal outcomes.

EPIDEMIOLOGY

Maternal mortality is defined as “the death of a woman during pregnancy up to 42 days after delivery or termination of pregnancy.”1 According to the Centers for Disease Control and Prevention (CDC), the rate of maternal mortality has increased from 7.2 deaths per 100,000 live births in 1987 to as high as 17.8 deaths per 100,000 live births in years 2009 and 2011 (Fig. 38-1).2 The main causes of maternal death in the United States are cardiac disease, infection, hemorrhage, embolism, and hypertensive disorders (Fig. 38-2).2 This chapter will focus on cardiac arrest.

FIGURE 38-1.

Trends in pregnancy-related mortality from 1987 to 2012 from the CDC. Mortality increased from 7.2 deaths per 100,000 live births in 1987 to 17.8 deaths per 100,000 live births in 2009 and 2011. *Note: Number of pregnancy-related deaths per 100,000 live births per year.

FIGURE 38-2.

Causes of pregnancy-related ...

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