title: Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency skills training?
abstract: OBJECTIVE
  Management of cardiac arrest in pregnancy is recommended to include perimortem caesarean section (PMCS) in the Managing Obstetric Emergencies and Trauma (MOET) course. In this study, we aimed to assess maternal and neonatal outcome of all cases of PMCS in the Netherlands performed in the last 15 years, and to test the hypothesis that PMCS was used more often since the introduction of the MOET-course in 2004.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Nationwide assessment of all cases of PMCS inside or outside hospitals.
  
  
  METHODS
  All known cases of PMCS in the Netherlands from 1993 to 2008.
  
  
  METHODS
  Data collection through contacting all Dutch obstetricians and all MOET and Advanced Trauma Life Support instructors. All cases of cardiac arrest during pregnancy were collected by cross-checking with data from the Dutch Maternal Mortality Committee and a nationwide severe maternal morbidity study.
  
  
  METHODS
  Incidence and case fatality rate of PMCS. Incidence of PMCS before and after introduction of the MOET course. Maternal and neonatal outcome and the process of the PMCS were analysed.
  
  
  RESULTS
  During the study period, 55 women had a cardiac arrest, 12 of whom underwent a PMCS. Before the introduction of the MOET course, four PMCSs were performed (0.36/year), compared with eight cases after its introduction (1.6/year, P = 0.01). No PMCS was performed within the recommended 5 minutes after starting resuscitation. Eight of the twelve women (67%) regained cardiac output after PMCS, with two maternal and five neonatal survivors. Maternal case fatality rate was 83%. Neonatal case fatality rate was 58%.
  
  
  CONCLUSIONS
  Since the introduction of the MOET course, the use of PMCS has increased. Outcome, however, was still poor. An important factor to improve outcome is more timely application of this potentially life-saving procedure.
authors.affiliation: Department of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam, the Netherlands. a.dijkman@erasmusmc.nl
authors.forename: A
authors.initials: A
authors.lastname: Dijkman
authors.forename: C M A
authors.initials: CM
authors.lastname: Huisman
authors.forename: M
authors.initials: M
authors.lastname: Smit
authors.forename: J M
authors.initials: JM
authors.lastname: Schutte
authors.forename: J J
authors.initials: JJ
authors.lastname: Zwart
authors.forename: J J
authors.initials: JJ
authors.lastname: van Roosmalen
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
mesh_terms: D000328:Adult; D022561:Advanced Cardiac Life Support / Q000193:education*; D001034:Apgar Score; D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data*; D004502:Education, Medical, Continuing / Q000379:methods*; D004630:Emergencies; D004812:Epidemiologic Methods; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D009426:Netherlands / Q000453:epidemiology; D009774:Obstetrics / Q000193:education; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult