Cardiac arrest in pregnancy

Despite the fact that the incidence of cardiac arrest (CA) in pregnancy has been greatly reduced over the last decades, it constitutes nevertheless a tragic fatality affecting two lives at the same time. Furthermore, the family as well as the medical and nursing staff may face severe emotional and economical implications. Optimal outcomes are rarely observed and are dependent upon early recognition of the imminent CA, the cause of the arrest and the rapid response of the rescue team and attending healthcare personnel. The present chapter reviews the major pathophysiological changes occurring in mother's organism during pregnancy, the incidence of CA during pregnancy throughout the world and the differences observed between countries with a special focus on the varying conditions and causes of maternal death among developed and undeveloped countries. The implications of preexisting diseases as causes of maternal CA are discussed, as well as the impact of situations developed during pregnancy, such as eclampsia. In addition to the above, special attention is given to medical and especially anesthetic complications resulting in maternal death. Management of CA during pregnancy is discussed under the light of the International Liaison Committee on Resuscitation 2010 Guidelines. Perimortem caesarean section which should be undertaken immediately after a difficult decision process represents a major crisis for the physician managing this case. Ultimately, following the current treatment algorithms and treating the possible reversible causes under the light of the special pathophysiologic conditions present in pregnancy, guaranties the best possibilities of successful return of spontaneous circulation.