Resuscitation in pregnancy

Introduction

Cardiac arrest occurs only about once in every 30 000 late pregnancies, but survival from such an event is exceptional. Most deaths are from acute causes, with many mothers receiving some form of resuscitation. However, the number of indirect deaths–that is, deaths from medical conditions exacerbated by pregnancy–is greater than that of deaths from conditions that arise from pregnancy itself. The use of national guidelines can decrease mortality, as shown by the reduction in the numberof deaths from pulmonary embolus and sepsis after caesarean section. To try to reduce mortality from amniotic fluid embolism, a national database for suspected cases has been established.

Factors peculiar to pregnancy that weigh the balance against survival include anatomical changes that make it difficult to maintain a clear airway and perform intubation, pathological changes such as laryngeal oedema, physiological factors such as increased oxygen consumption, and an increased likelihood of pulmonary aspiration. In the third trimester the most important factor is compression of the inferior vena cava and impairment of venous return by the gravid uterus when the woman lies supine. These difficulties may be exaggerated by obesity. All staff directly or indirectly concerned with obstetric care need to be trained in resuscitation.

A speedy response is essential. Once respiratory or cardiac arrest has been diagnosed, the patient must be positioned appropriately and basic life support started immediately. This must be continued while venous access is secured, any obvious causal factors are corrected (for example, hypovolaemia), and the necessary equipment, drugs, and staff are assembled.

Basic life support