Dr Simon Apps1, Dr Tabitha Tanqueray1, Dr Charlotte Frise2
1Homerton Healthcare NHS Foundation Trust, London, United Kingdom, 2Imperial College Healthcare NHS Trust, London, United Kingdom
Biography:
Charlotte Frise is a consultant Obstetric Physician and is Lead Obstetric Physician for the NW London Maternal Medicine network. She is a senior college lecturer in Clinical Medicine at Keble College, Oxford. She is co-editor-in-chief of the journal Obstetric Medicine. She has also authored two textbooks about Obstetric Medicine
Abstract:
Introduction: The maternal cardiac arrest rate in the UK is 1 in every 36,000 pregnancies.1 Accurately identifying the cause of cardiac arrest during the intrapartum period can be difficult for the clinical team on the labour ward, and also for review panels looking into cases of maternal cardiac arrest retrospectively. Conditions like amniotic fluid embolism may be overdiagnosed, as it can often be difficult to make an accurate diagnosis amid the complexities of the intrapartum period.2
Objective: The aim of this work was to create a visual summary of the causes of intrapartum cardiac arrest. This can then be used by clinicians and maternal review panels to identify the cause of intrapartum cardiac arrest more accurately.
Method: A literature review was conducted looking at the different causes of intrapartum cardiac arrest. A more detailed review of each condition was then conducted to summarise their symptoms, signs, maternal observations, and relevant results of maternal and fetal assessment.
Results: A visual summary of the causes of intrapartum cardiac arrest, sectioned into direct, cardiac, anaesthetic, and other causes. The symptoms, signs, maternal observations, investigation results and CTG features of the different causes are presented.
Discussion: The intrapartum period is dynamic, with acute physiological changes occurring over a short period of time along with the potential for numerous complications. The possible causes of true intrapartum cardiac arrest are therefore more limited than that of cardiac arrest in pregnancy in general and require special consideration.
The summary will serve as a resource to teams presented with an intrapartum cardiac arrest, allowing for rapid diagnosis and more tailored management. It can also be a resource for post-event reviews to ensure accurate reporting of these events. Differentiating the causes of intrapartum cardiac arrest will provide essential guidance to clinical teams and improve patient safety.
Keywords
Cardiac arrest, collapse, intrapartum
References
1 Beckett V, Knight M, Sharpe P. The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study. BJOG Int J Obstet Gynaecol 2017; 124: 1374–81.
2 Clark SL. Amniotic Fluid Embolism. Obstet Gynecol 2014; 123: 337–48.