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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

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