A ten-year retrospective review of maternal cardiac arrest: Incidence, characteristics, causes, and outcomes in a tertiary-care hospital in a developing country

Successfully conservative management of the uterus in acute pulmonary embolism during cesarean section for placenta previa: a case report from Tu Du Hospital, Vietnam and literature review

BACKGROUND

Cardiopulmonary collapse is a catastrophic event in cesarean section, which leads to adverse outcomes for both the mother and the fetus. Pulmonary embolism is one of the rare etiologies of this entity. We herein reported the successful management of acute embolism pulmonary associated with cesarean delivery on a healthy pregnant woman at our tertiary referral hospital.

CASE PRESENTATION

A full-term pregnant woman hospitalized for planned cesarean delivery due to placenta previa without cardiorespiratory diseases. She was scheduled uneventfully for a planned cesarean section. After placental delivery, the patient spontaneously fell into cardiopulmonary collapse and her vital signs deteriorated rapidly. The obstetricians promptly completed the cesarean section and performed all procedures to prevent the PPH and preserve the uterus. At the same time, the anesthesiologists continued to carry out advanced heart-lung resuscitation in order to control her vital signs. After surgery, the multidisciplinary team assessed the patient and found a thrombus in her pulmonary circulation. Therefore, the patient was managed with therapeutic anticoagulation. The patient recovered in good clinical condition and was discharged after 2 weeks without any complications.

CONCLUSIONS

The diagnosis of acute pulmonary embolism is extremely difficult due to uncommon occurrence, sudden onset, and non-specific presentation. Awareness of this life-threatening pathology during cesarean delivery should be raised. Interdisciplinary assessment must be essentially established in this life-threatening condition. After the whole conventional management, uterine conservation may be acceptable where applicable. Further data is required to encourage this finding.

An in-depth analysis of maternal mortality in a quaternary university hospital in Southern Thailand: A 16-year experience

OBJECTIVE

To perform an in-depth analysis and evaluate the causes of maternal deaths in a university hospital in Southern Thailand.

METHODS

A retrospective descriptive study was conducted. Medical records of all women who died during pregnancy or within 42 days of termination of pregnancy at Songklanagarind Hospital from January 2006 to December 2021 were reviewed.

RESULTS

There were 51 910 live births during the 16-year period and 68 maternal deaths (31 of direct cause, 36 of indirect cause, and one of unknown cause). The maternal mortality ratio was 131 per 100 000 live births. There was a decreasing trend in the maternal mortality ratio, especially during the past 4 years. The leading causes of death were cardiac disease (n = 17), hypertensive disorders in pregnancy (n = 9), and postpartum hemorrhage (n = 7). The most common indirect causes of maternal death were cardiac disease, hematologic disease, and dengue hemorrhagic fever. There was a decreasing trend in indirect to direct deaths ratios during three study periods. Ratios in 2006 to 2010, 2011 to 2015, and 2016 to 2021 were 1.6, 1.4, and 0.5, respectively.

CONCLUSIONS

The three leading causes of death were cardiac disease, hypertensive disorders in pregnancy, and postpartum hemorrhage. Improvements in the quality of obstetric care at all hospital levels are required.

Assessment and Prediction of Cardiovascular Contributions to Severe Maternal Morbidity

Severe maternal morbidity (SMM) refers to any unexpected outcome directly related to pregnancy and childbirth that results in both short-term delivery complications and long-term consequences to a women's health. This affects about 60,000 women annually in the United States. Cardiovascular contributions to SMM including cardiac arrest, arrhythmia, and acute myocardial infarction are on the rise, probably driven by changing demographics of the pregnant population including more women of extreme maternal age and an increased prevalence of cardiometabolic and structural heart disease. The utilization of SMM prediction tools and risk scores specific to cardiovascular disease in pregnancy has helped with risk stratification. Furthermore, health system data monitoring and reporting to identify and assess etiologies of cardiovascular complications has led to improvement in outcomes and greater standardization of care for mothers with cardiovascular disease. Improving cardiovascular disease-related SMM relies on a multipronged approach comprised of patient-level identification of risk factors, individualized review of SMM cases, and validation of risk stratification tools and system-wide improvements in quality of care. In this article, we review the epidemiology and cardiac causes of SMM, we provide a framework of risk prediction clinical tools, and we highlight need for organization of care to improve outcomes.

Out-of-hospital cardiac arrest in pregnant women: a 55-patient French cohort study

AIM

To describe a cohort of pregnant women having suffered an out-of-hospital cardiac arrest (OHCA) and to compare them with nonpregnant women of childbearing age having suffered OHCA.

METHODS

Study data were extracted from the French National OHCA Registry between 2011 and 2021. We compared patients in terms of characteristics, care and survival.

RESULTS

We included 3,645 women of childbearing age (15-44) who had suffered an OHCA; 55 of the women were pregnant. Pregnant women were younger than nonpregnant victims (30 vs. 35 years, p=0.006) and were more likely to have a medical history (76.4% vs. 50.5%, p<0.001) and a medical cause of the OHCA (85.5% vs. 57.2%, p<0.001). Advanced Life Support was more frequently administered to pregnant women (98.2%, vs. 72.0%; p<0.001). In pregnant women, the median time of MICU arrival was 20 minutes for the Medical Intensive Care Unit with no difference with nonpregnant women. Survival rate on admission to hospital was higher among pregnant women (43.6% vs. 27.3%; p=0.009). There was no difference in 30-day survival between pregnant and nonpregnant groups (14.5% vs. 7.3%; p=0.061). Fetal survival was only observed for OHCAs that occurred during the pregnancy second or third trimester (survival rates: 10.0% and 23.5%, respectively).

CONCLUSIONS

Our results show that resuscitation performance does not meet European Resuscitation Council's specific guidelines on OHCA in pregnant women. Although OHCA in pregnancy is rare, the associated prognosis is poor for both woman and fetus. Preventive measures should be reinforced, especially when pregnant women have medical history.