February 24, 2017

expert reaction to research into cardiac arrest in pregnancy

In BJOG: An International Journal of Obstetrics and Gynaecology scientists describe the incidence, risks, management and outcomes of cardiac arrest in pregnancy in the UK population.

Dr Robert Stephens, AMS Research Training Fellow in Anaesthesia/Intensive Care at the Institute of Child Health, University College London, said:

“In the paper reported by the authors they found 66 cardiac arrests, 16 of which were attributable to obstetric anaesthesia, although none of these women died: all the deaths were due to other causes (such as blood loss, blood clots etc)

“According to the major MBBRACE report 2012-2014 (which looks at UK maternal deaths over every 3 year period), cardiac disease was the leading overall cause of maternal death, with 51 deaths reported.  But of all 200 deaths reported and investigated, anaesthesia was the cause identified in only 2 of the deaths. This is an all-time low for anaesthesia, and can be attributed in part to the increasing use of regional anaesthetic techniques for elective and emergency operative deliveries.

“The third national audit project (‘NAP3’) of the Royal College of Anaesthetists looking at major complication of regional anaesthesia (epidurals and/or spinals): over 320,425 were carried out over a one year period across the UK. Cardiovascular collapse was only reported in 3 cases in total. In the obstetric anaesthesia, the incidence of permanent harm was estimated to be 0- 0.6 per 100,000.

“Recognised complications of regional anaesthesic/analgesic techniques such as epidurals can cause symptoms in the mother such as nausea, vomiting, light headedness and (very rarely) loss of consciousness. The drop in the maternal blood pressure is a relatively common occurrence during spinal anaesthesia for caesarean section, and is well documented. Another recognised, but extremely rare complication cited in the article would be a total spinal or high epidural block, but this is usually short-lived and only a short period of support is required until the block level goes down.

“On the labour ward both of these events can result in a cardiac arrest call on the labour ward, despite the fact that there is no loss of the maternal cardiac output, and is used as a method to gain additional equipment and support for the emergency situation.

“It is my personal experience and opinion that central neuraxial techniques in obstetric anaesthesia are exceptionally safe and effective, and have contributed to a marked reduction in maternal mortality from anaesthesia. In larger mothers especially we would recommend getting an early epidural as the risks of having an urgent anaesthetic in a hurry is much more risky as it might mean they have to have general anaesthesia. Women giving birth should be reassured that epidurals are extremely safe procedures.”

* ‘The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study’ by VA Beckett et al. published in BJOG: An International Journal of Obstetrics and Gynaecology on Friday 24 February 2017.

Declared interests

None declared