[Analysis of the cause and clinical characteristics of maternal cardiac arrest].
OBJECTIVE
To analyze the cause and clinical characteristics of maternal cardiac arrest.


METHODS
The data of all cases of maternal cardiac arrest from January 2005 to December 2009 in Third Affiliated Hospital of Guangzhou Medical College was retrospectively studied.


RESULTS
(1) A total of 41 maternal cardiac arrests (6 in prenatal period, 2 in the first stage of labor, 7 in the third stage of labor, 26 in postpartum period) were included. All patients regained spontaneous circulation after basic life support. Twelve (29%) mothers survived. Twelve cardiac arrests occurred in the hospital, and the total delivery number from January 2005 to December 2009 was 17 101, with occurrence rate of 1:1425. (2) The causes of arrest were hemorrhagic shock (12, 29%), amniotic fluid embolism (7, 17%), severe preeclampsia/eclampsia (7, 17%), septic shock (6, 15%), cardiac disease (2, 5%), unidentified cause (2, 5%) and other occasional causes. (3) Thirty-seven (90%) in-hospital maternal cardiac arrest occurred in operation room (16, 39%), ICU (7, 17%), maternity wards (6, 15%), delivery room (5, 12%) and the emergency room (3, 7%). Three (7%) arrest occurred out of hospital and one in the ambulance. Maternal survival rate was 2/3 in the emergency room, 8/16 in the operation room, 1/5 in the maternity wards, and 1/6 in the delivery room. No mother survived in ICU, ambulance or out of hospital. (4) Five of the 12 survived women showed ischemic encephalopathy after cardiac arrest and one of them developed cerebral infarction in the right corona radiate. (5) In 4 of the 8 cases of cardiac arrest in pregnancy, perimortem caesarean section (PMCS) was performed. In the four PMCS, 2 mothers and 2 children survived. In the 4 cases that PMCS was not carried out, no infant survived.


CONCLUSIONS
Hemorrhagic shock, severe preeclampsia and eclampsia, amniotic fluid embolism are the major obstetric causes of maternal cardiac arrest. Septic shock and cardiac diseases are the major non-obstetric causes. Cardiac arrests occurred in emergency room and operation room has a higher maternal survival rate than those occurred in the delivery room and maternity wards. Timely PMCS may ensure the optimal outcome for mothers and fetuses.
Department of Obstetrics, Third Affiliated Hospital of Guangzhou Medical College, Guangzhou 510150, China.
Tian-qing
TQ
Huang
Dun-jin
DJ
Chen
Hui-shu
HS
Liu
Man-hua
MH
Dai
Dong-jian
DJ
Huang
D000328:Adult; D016887:Cardiopulmonary Resuscitation; D002585:Cesarean Section; D004619:Embolism, Amniotic Fluid / Q000453:epidemiology; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012771:Shock, Hemorrhagic / Q000150:complications* / Q000453:epidemiology; D055815:Young Adult