Skip to Main Content

Chapter 25: Resuscitation in Pregnancy

Boyd D. Burns; Emily C.S. Fisher

INTRODUCTION AND EPIDEMIOLOGY

Cardiac arrest in pregnancy is rare, and resuscitation of a pregnant woman is typically an unexpected and chaotic event, which ideally involves multiple consultants from different specialties with different levels and types of skills. Emergency care and lifesaving procedures for resuscitation and cardiac arrest should not be delayed if specialists are not available. Contact the closest center providing neonatal and maternal services as soon as possible to facilitate rapid transport and continued care of the newly delivered infant and the mother.

The World Health Organization defines maternal deaths as deaths while pregnant or within 42 days of the end of pregnancy, related to or aggravated by pregnancy or pregnancy management, regardless of the duration or site of the pregnancy and irrespective of the cause of death.1 Factors associated with pregnancy-related deaths in the United States include advanced maternal age, African-American race, increasing live birth order, and lack of prenatal care.2

Recent U.S. data demonstrate that cardiac arrest, in the inpatient setting, occurs in 1:12,000 admissions.3 The trend in maternal mortality in the United States, according to the Centers for Disease Control and Prevention, has seen a steady increase from 7.2 deaths per 100,000 live births in 1987 to 17.8 deaths per 100,000 live births in 2009.4

Management of emergencies during labor and delivery is discussed in Chapter 101, “Emergency Delivery.”

PHYSIOLOGY OF PREGNANCY

Beginning early in pregnancy, virtually all major organ systems undergo changes (Table 25-1) that affect patient management.

TABLE 25-1Physiologic Changes in Pregnancy Affecting Resuscitation
View Table||Download (.pdf)
TABLE 25-1 Physiologic Changes in Pregnancy Affecting Resuscitation
System Parameters Comment
Cardiovascular Cardiac output Increases 30%–50%
Peripheral resistance Decreases 20%
Blood pressure Decreases 10–15 mm Hg systolic in first half of pregnancy; then back to baseline
Blood volume 100 mL/kg or 6–7 L
Central venous pressure May be increased up to 10 mm Hg
Central venous oxygen saturation Increases as high as 80%5
Plasma volume Increases 30%–50%
Hematologic Fibrinogen, factors V, VII, VIII, X, von Willebrand factor Increase, with heightened risk for venous thromboembolism in second half of pregnancy
Respiratory and pulmonary Upper airway edema, hyperemia, and friability Estrogen and volume effects; can result in difficult airway
Diaphragm elevation Higher thoracostomy tube insertion site during pregnancy
Hemoglobin F has greater affinity for oxygen than maternal hemoglobin Fetal oxygen maintained at expense of maternal oxygenation; maintain maternal oxygen saturation >95%
Respiratory rate No change
Tidal volume, minute ventilation Increase
Renal and urinary Progesterone dilates renal collecting system; ureteral peristalsis decreases Renal US may show mild hydronephrosis; increased risk for ascending infection
GI Alkaline phosphatase rises from placental production; bile is more lithogenic Increased risk of cholecystitis/cholelithiasis
Decreased lower esophageal tone; decreased gastric emptying Increased likelihood of aspiration of gastric contents
Uteroplacental unit 25% of blood ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close