Cardiac Arrest in Pregnancy

Key points

• The risk of death following a cardiac arrest in pregnancy is extremely high for both mother and child, but both can be resuscitated if fast action is taken.
• Cardiac arrest is managed by resuscitation and perimortem caesarean section (PMCS).
• There is little information on survivors of cardiac arrest or PMCS.
• This study will investigate the current incidence of cardiac arrest and PMCS in pregnancy. It will describe the current management by resuscitation and PMCS, the associated outcomes for women and their infants and will help to develop guidelines for optimal management.

Surveillance Period

July 2011-June 2014

Background

Cardiac arrest in pregnancy affects around 1:30 000 women^[1]; incidence is thought to be rising due to the increasing age and morbidity of the antenatal population in the UK. The risk of death for mother and child is extremely high but some causes of cardiac arrest are reversible. Aggressive resuscitation is required, including caesarean section in most cases over 20 weeks gestation. The importance of rapid delivery after cardiac arrest for maternal benefit is becoming a widely accepted practice and there is evidence to suggest that MOET (Managing Obstetric Emergencies & Trauma) training in obstetric resuscitation is leading to an increase in the use of PMCS in maternal cardiac arrest in the UK^[2] and in Europe^[3]. In the UK 52 cases of PMCS were recorded between 2003-2005 amongst women who subsequently died^[4].

There is, however, minimal information on survivors of cardiac arrest or PMCS. This study will investigate the incidence, management (including PMCS) and outcomes of maternal cardiac arrest including both women who survive and women who die. This information will be used to establish optimal management guidelines to improve survival of mother and infant.

Objectives

• To use the UK Obstetric Surveillance System to describe the epidemiology of cardiac arrest in pregnancy, and the use of perimortem caesarean section (PMCS), in the UK.
• To use this information to assess current practice, develop future guidelines for optimal management of cardiac arrest and aid in decision making on the use of PMCS.

Research questions

• What is the current incidence of cardiac arrest in pregnancy in the UK?
• How often is PMCS used in resuscitation following cardiac arrest in pregnancy?
• What is the outcome for mother and baby following cardiac arrest with or without PMCS?
• What are the characteristics of women who suffer cardiac arrest in pregnancy?
• How is the resuscitation conducted and what interventions make a difference?

Case definition

Any pregnant women in the UK identified as receiving basic life support (chest compressions and, where possible, ventilation breaths), including women who have undergone PMCS.

Funding

This study is funded by Wellbeing of Women.

Ethics committee approval

The study has been approved by the NRES Committee Yorkshire & the Humber – Bradford (REC Ref. number 11/HY0202).

Investigators

• Virginia A. Beckett, Paul Sharpe, Laura McCarthy, Bradford Teaching Hospitals NHS Trust
• Marian Knight, NPEU

Download the Data Collection Form (DCF)

UKOSS Cardiac Arrest in Pregnancy Form