Out-of-hospital cardiac arrest in pregnancy with good neurological outcome for mother and infant

Perimortem Caesarean section because of a live fetus: case report and literature review

BACKGROUND

Perimortem Caesarean section (PMCS) is a rare surgical procedure that is potentially lifesaving for mother and child.

AIM

To describes a live fetus 1 h after maternal cardiac arrest and a rare hospital surgical event, PMCS.

CASE REPORT

We report on a 22-year-old gravida 1 para 1 woman who had a convulsive loss of consciousness at 31 weeks' gestation. A convulsive loss of consciousness was accompanied by profuse vomiting of gastric contents. Cardiopulmonary resuscitation was initiated. Fetal heartbeats were recorded and the patient was referred to the Clinic for Gynecology and Obstetrics. Perimortem Caesarean section was performed. Neonatal cardiopulmonary resuscitation was initiated, but the infant was pronounced dead after 60 min of attempted resuscitation. Maternal cardiopulmonary resuscitation was without success and it was abandoned following discussion with family members.

CONCLUSION

A cooperative team approach is the key factor to producing a good perinatal outcome.

[Cardiopulmonary resuscitation of pregnant patients in the rescue service]

Cardiopulmonary resuscitation of a pregnant patient is a rarity in prehospital emergency medicine and an extraordinary challenge for the emergency team. Besides modifications to emergency medical procedures due to physiological changes during pregnancy, specific reversible causes must be considered and psychosocial difficulties must be managed. This article aims to present a standard operating procedure for this special situation. In these circumstances the basics of crew resource management (CRM) are of special interest for the emergency team and are therefore mentioned in this article.

Maternal out-of-hospital cardiac arrest: A retrospective observational study

AIM

Out-of-hospital cardiac arrests (OHCAs) in pregnant women are rare events. In this study, we aimed to describe a cohort of pregnant women who experienced OHCAs in a large urban area, and received treatment by the prehospital teams in a two-tiered emergency response system.

METHODS

This retrospective study included pregnant women over 18 years of age who experienced OHCAs. The analysed variables included maternal age, gestational age, variables specific to the rescue system, number of shocks delivered by an automatic external defibrillator, and rates of maternal and neonatal survival.

RESULTS

Over the 5-year study period, 19,515 OHCAs occurred, 16 of which were in pregnant women. These 16 patients had a median age of 31 years [interquartile range (IQR): 28-35] and a median gestational age of 20 weeks [IQR: 10-33]. Three patients (18.8%) had an initial rhythm of ventricular fibrillation. Only one patient underwent thrombolysis. Of the 16 patients, 6 (38%) died after resuscitation on the scene. The remaining 10 were transported to the hospital, of whom 5 achieved circulation through a mechanical CPR device. Only 2 patients were alive 30days after OHCA.

CONCLUSIONS

Over half of the pregnant women who experienced OHCA were at least 20 weeks pregnant. Analysis of the prehospital medical data suggests that the current recommendations are difficult to apply in an out-of-hospital environment. Specific recommendations for this situation must be developed.