Cardiac Arrest During Pregnancy

Question 1

Reversible causes of adult cardiac arrests

Answer 1

4 Ts:

Thrombosis (i.e. PE or MI)
Tension pneumothorax
Toxins
Tamponade (cardiac)

4 Hs:

Hypoxia
Hypovolaemia
Hypothermia
Hyperkalaemia, hypoglycaemia, and other metabolic abnormalities

Question 2

Causes of cardiac arrest specific to pregnancy

Answer 2

Eclampsia
Antepartum or postpartum haemorrhage
Pulmonary embolism
Sepsis

Question 3

Causes of massive obstetric haemorrhage

Answer 3

Placenta accreta 
Placental abruption 
Placenta praevia 
Vasa praevia 
Ectopic pregnancy 
Uterine rupture

Question 4

Aortocaval Compression

Answer 4

Compression of uterus on the vena cava that can cause cardiac arrest after 20 weeks

Question 5

Management of aortocaval compression

Answer 5

Lie on the side - left lateral position

Question 6

Resuscitation in Pregnancy

Answer 6

A 15 degree tilt to the left side for CPR, to relieve compression of the inferior vena cava and aorta

Early intubation to protect the airway

Early supplementary oxygen

Aggressive fluid resuscitation (caution in pre-eclampsia)

Delivery of the baby after 4 minutes, and within 5 minutes of starting CPR

Question 7

Complication of pregnancy on resuscitation

Answer 7

Aortocaval compression
Increased oxygen requirements
Splinting of the diaphragm by the pregnant abdomen
Difficulty with intubation
Increased risk of aspiration
Ongoing obstetric haemorrhage

Question 8

When is immediate caesarean section performed in a pregnant woman

Answer 8

There is no response after 4 minutes to CPR performed correctly

CPR continues for more than 4 minutes in a woman more than 20 weeks gestation

Question 9

When should the baby be delivered

Answer 9

Within 5 minutes of CPR commencing - operation performed at the site of the arrest