Nearly one in four cardiac arrests in pregnancy is linked to complications of obstetric anaesthesia, according to an analysis published today.
A three-year study, published in BJOG: An International Journal of Obstetrics and Gynaecology, also showed that rapid perimortem caesarean section (PMCS) saves women’s lives when they have a cardiac arrest in pregnancy.
The study found that 66 women in the UK had a cardiac arrest in pregnancy between 2011 and 2014 and 49 had a PCMS. Dr Virginia Beckett, lead author and consultant obstetrician and gynaecologist at Bradford Teaching Hospitals NHS Foundation Trust, said that cardiac output was restored in 48. A total of 58 babies were delivered, while 12 were stillborn.
Dr Beckett and her team found that the obstetric anaesthesia, given as an epidural, spinal or combined spinal-epidural, was associated with the cardiac arrest. Out of the 66, 16 had a cardiac arrest following obstetric anaesthesia and all survived.
Of those 16, 12 were obese, which supports the view that obese pregnant women are at a higher risk of complications of anaesthesia.
The study also shows that hypovolaemia, venous thromboembolism and amniotic fluid embolism are the main non-anaesthetic causes of cardiac arrest.
Out of the 66, 27 had co-morbidities which may have contributed to maternal arrest.
Calling for further research, Dr Beckett said: “Our study shows that management of cardiac arrest in pregnancy in the UK, following the introduction of training such as the Managing Obstetric Emergencies and Trauma (MOET) course, has resulted in a 58% maternal survival rate. The main reasons for this appear to be the involvement of senior medical professionals and swift PMCS.
“American data shows that up to one third of women who arrest die with their baby still in utero. In the UK, we take a very different approach; in this study, PMCS was carried out in 49 (74%) of the 66 women involved (only two women remained undelivered when they should have had a PMCS). This is close to a five-fold improvement. Rapid PMCS saves women’s lives.
“However, our study shows that the single, biggest association of maternal cardiac arrest is a complication of anaesthesia.”
Mr Edward Morris, vice president for clinical quality at the Royal College of Obstetricians and Gynaecologists (RCOG), added: “Childbirth can be unpredictable and timely access to specialist care is critical; especially for those considered at higher risk due to pre-existing health conditions. This data supports existing evidence that maternal cardiac arrest is becoming more common, and there may be opportunities to further improve survival rates through detailed analysis of this data.”
Beckett VA, Knight M, and Sharpe P: The CAPS Study: Incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study. BJOG 24 February 2017; doi: 10.1111/1471-0528.14521
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