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Cardiac arrest during childbirth more frequent than believed

Thursday March 20, 2014
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Although cardiac arrest during childbirth is rare, it may be two times more common than previously reported in the literature, according to a study.

The study, based on data for more than 56 million births, also found that cardiopulmonary resuscitation often was successful, and that the survival rate improved between 1998 and 2011.

More than one in 12,000 American women suffer from cardiac arrest during hospitalization for childbirth, according to the study, which was published in the April issue of the journal Anesthesiology and was described as the first large U.S. study on maternal cardiac arrest. Researchers determined women who suffered cardiac arrest were more likely to be older, to be black or to receive care funded by Medicaid.

A number of health issues that may occur during childbirth can lead to cardiac arrest, including excessive bleeding, heart failure, myocardial infarction, preeclampsia, blood infection and amniotic fluid embolism. These issues can cause irregular heart rhythms or reduced blood flow and oxygen to the heart.

“These are rare high-stakes events on obstetric units, and team preparation is critical to ensure that everyone is ready to act quickly and effectively,” Jill M. Mhyre, MD, lead author of the study and associate professor of anesthesiology at the University of Arkansas for Medical Sciences, Little Rock, said in a news release. “Fortunately, physician anesthesiologists are experts in leading resuscitation teams for maternal cardiac arrest and other emergencies that happen on the labor floor.”

Using data from the federal Nationwide Inpatient Sample — the largest all-payer inpatient healthcare database in the U.S. — researchers identified 4,843 cardiac arrest events among 56,900,512 hospitalizations for childbirth, a rate of one in 11,749.

The main causes of cardiac arrest included bleeding (44.7%), heart failure (13.3%), amniotic fluid embolism (13.3%) and sepsis (11.2%). Survival improved from 52% in 1998 to 60% in 2011.

“A 60% rate of survival from cardiac arrest is good, but maternal mortality in the United States remains unacceptably high,” Mhyre said. “This information will assist healthcare providers to deliver the most effective maternal cardiopulmonary resuscitation when both the mother’s and baby’s lives are on the line.”

The study notes the 60% survival rate exceeds that which had been previously reported in the literature. The authors hypothesize that this survival rate may reflect the relative health and fitness of women in the childbearing population.

Study: http://journals.lww.com/anesthesiology/Fulltext/2014/04000/Cardiac_Arrest_during_Hospitalization_for_Delivery.16.aspx


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