Elsevier

Advances in Anesthesia

Volume 38, December 2020, Pages 229-250
Advances in Anesthesia

Anesthesia for Obstetric Disasters

https://doi.org/10.1016/j.aan.2020.09.001Get rights and content

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Key points

  • •

    In the United States, increases in cardiovascular disease, cardiomyopathy, and cerebrovascular accidents are significantly contributing to the increase in maternal mortality.

  • •

    Over the past 30 years, maternal mortality secondary to obstetric hemorrhage, hypertensive disorders of pregnancy, and anesthetic complications has improved.

  • •

    Obstetric hemorrhage remains the leading contributor to maternal cardiac arrest in the United States.

  • •

    Knowledge of best practices in obstetric anesthesia is critical to

Maternal mortality

In 1986, the Centers for Disease Control and Prevention initiated surveillance of maternal deaths.1 Pregnancy-related death is defined as the “death of a woman while pregnant or within 1 year of the end of a pregnancy that was caused by pregnancy or its physiologic effects, a complication of the pregnancy or its management.”1 Between 1987 and 2013, maternal mortality in the United States increased from 7.2 to 18.0 deaths per 100,000 live births.1

Traditional causes of maternal mortality, such as

Cardiac arrest in pregnancy

Although rare, maternal cardiac arrest may lead to significant maternal and fetal morbidity and mortality. Population-based data in the United States, the United Kingdom, and Canada reveal an estimated incidence between 1:12,000 and 36,000 hospitalizations for delivery with survival rates to hospital discharge between 40.7% and 71.3%.7, 8, 9, 10

Maternal risk factors for cardiac arrest in pregnancy include parturients who are greater than 35 years of age, gestational age less than 37 weeks,

Obstetric Hemorrhage

Maternal hemorrhage is the leading cause of cardiac arrest during hospitalization for delivery in the United States.8,17 Survival of maternal hemorrhage continues to improve but is associated with blood transfusion and hysterectomy.2,18,19 The American College of Obstetricians and Gynecologists’ reVITALize program has recently redefined postpartum hemorrhage (PPH) as “total blood loss greater than or equal to 1000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours

High Neuraxial Anesthesia Blockade

High neuraxial anesthesia blockade (HNAB) may occur in the setting of epidural anesthesia via unintentional injection of local anesthetic into the subarachnoid or subdural space, migration of an epidural catheter into the subdural or subarachnoid space, or overdose of local anesthetic in the spinal or epidural space. The Serious Complications Repository Project identifies the incidence of high neuraxial block as 1:4336 obstetric anesthetics with unrecognized spinal catheters identified in

Disclosure

The authors have nothing to disclose.

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References (63)

  • Pregnancy related mortality surveillance

  • A.A. Creanga et al.

    Pregnancy-related mortality in the United States, 2011-2013

    Obstet Gynecol

    (2017)
  • A.A. Creanga et al.

    Maternal mortality and morbidity in the United States: where are we now?

    J Womens Health (Larchmt)

    (2014)
  • K.S. Joseph et al.

    Factors underlying the temporal increase in maternal mortality in the United States

    Obstet Gynecol

    (2017)
  • W.M. Callaghan et al.

    Severe maternal morbidity among delivery and postpartum hospitalizations in the United States

    Obstet Gynecol

    (2012)
  • A.A. Creanga et al.

    Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008-2010

    Am J Obstet Gynecol

    (2014)
  • C.M. Zelop et al.

    Characteristics and outcomes of maternal cardiac arrest: a descriptive analysis of Get with the guidelines data

    Resuscitation

    (2018)
  • J.M. Mhyre et al.

    Cardiac arrest during hospitalization for delivery in the United States, 1998-2011

    Anesthesiology

    (2014)
  • V.A. Beckett et al.

    The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study

    BJOG

    (2017)
  • M. Balki et al.

    Epidemiology of cardiac arrest during hospitalization for delivery in Canada: a nationwide study

    Anesth Analg

    (2017)
  • F.M. Jeejeebhoy et al.

    Cardiac arrest in pregnancy: a scientific statement from the American Heart Association

    Circulation

    (2015)
  • S. Lipman et al.

    The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy

    Anesth Analg

    (2014)
  • D. Hui et al.

    The American Heart Association 2010 guidelines for the management of cardiac arrest in pregnancy: consensus recommendations on implementation strategies

    J Obstet Gynaecol Can

    (2011)
  • S.S. Lipman et al.

    Deficits in the provision of cardiopulmonary resuscitation during simulated obstetric crises

    Am J Obstet Gynecol

    (2010)
  • A. Hards et al.

    Management of simulated maternal cardiac arrest by residents: didactic teaching versus electronic learning

    Can J Anaesth

    (2012)
  • J. Adams et al.

    Management of maternal cardiac arrest in the third trimester of pregnancy: a simulation-based pilot study

    Crit Care Res Pract

    (2016)
  • L.E. Shields et al.

    ACOG practice bulletin number 183: postpartum hemorrhage

    Obstet Gynecol

    (2017)
  • M.S. Kramer et al.

    Incidence, risk factors, and temporal trends in severe postpartum hemorrhage

    Am J Obstet Gynecol

    (2013)
  • B.T. Bateman et al.

    The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries

    Anesth Analg

    (2010)
  • A. Bryant et al.

    The association of maternal race and ethnicity and the risk of postpartum hemorrhage

    Anesth Analg

    (2012)
  • Lyndon A, Lagrew D, Shields L, et al. Improving health care response to obstetric hemorrhage version 2.0. A California...
  • E.K. Main et al.

    National partnership for maternal safety: consensus bundle on obstetric hemorrhage

    Anesth Analg

    (2015)
  • R. Shaylor et al.

    National and international guidelines for patient blood management in obstetrics: a qualitative review

    Anesth Analg

    (2017)

  • Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with postpartum hemorrhage (WOMAN): an international, randomized, double-blind, placebo-controlled trial

    Lancet

    (2017)
  • L.D. Pacheco et al.

    Tranexamic acid for the management of obstetric hemorrhage

    Obstet Gynecol

    (2017)
  • H. Goucher et al.

    Cell salvage in obstetrics

    Anesth Analg

    (2015)
  • K.E. Fitzpatrick et al.

    Incidence, risk factors, management and outcomes of amniotic-fluid embolism: a population-based cohort and nested case-control study

    BJOG

    (2016)
  • M. Knight et al.

    Amniotic fluid embolism incidence, risk factors and outcomes: a review and recommendations

    BMC Pregnancy Childbirth

    (2012)
  • M.P. Bonnet et al.

    Maternal death due to amniotic fluid embolism: a national study in France

    Anesth Analg

    (2018)
  • S.L. Clark

    Amniotic fluid embolism

    Obstet Gynecol

    (2014)
  • L.D. Pacheco et al.

    SMFM Clinical Guidelines No. 9: amniotic fluid embolism: diagnosis and management

    Am J Obstet Gynecol

    (2016)

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    This article originally appeared in Anesthesiology Clinics, Volume 38, Issue 1, March 2020.

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