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Cardiac Arrest in a pregnant woman is the archetypal “high risk, low volume” situation for any obstetric department.  Despite the extremity of such a situation, we found a dearth of resources available in the obstetrical nursing literature to prepare staff for this clinical emergency.  To address our training needs, we developed and added “Maternal Cardiac Arrest with Perimortem C-Section” to the maternity department’s emergency simulations.
Not being a large teaching hospital, and operating with fewer personnel and resources in house, we recognize the heightened importance of having thorough plans in place to address any and all clinical emergencies.  In development of the adult “Code Blue” drill the authors researched emergency simulation trainings and identified significant differences in CPR procedure between pregnant and non-pregnant victims.   At times, situations could present which would necessitate a perimortem C-section to optimize outcomes in an otherwise tragic situation.  We realized that we needed a well thought out, well organized and practiced plan to deal with this rare but possible emergency.
“Current leading cause of arrest in late pregnancy is embolism followed by hemorrhage and hypertension (Berg et al. 1996;Bouvier-Colle et al. 1991.)”  Women positive for HIV of child bearing age, risk  infection which may escalate to cardiopulmonary arrest in pregnancy (Bongain et al, 1992; Kell et al, 1991.) 

At times, despite doing everything possible to save the mother’s life, maternal mortality may occur. The neonate’s survival and neurologic outcome are related to time between maternal death and delivery of the infant. Ideally, a perimortem C-section should be started within four minutes of maternal arrest.  Without adequate preparation for such an occurrence survival of the infant is unlikely.

“Code Blue” policy was amended to include procedure specific to resuscitation of a woman with a pregnant abdomen.  The authors revised Code Blue education including physiologic differences in the pregnant woman from her non-pregnant counterpart. Specific changes in the administration of CPR  were developed and, should all else fail, prompt initiation of perimortem C-section.  OB simulations were developed to train OB staff in the revised procedure.
The equipment needed to preform an emergency, perimortem C-section was assembled and this tray is kept on the obstetric department adult crash cart.   A similar perimortem tray will be located in the Emergency Department, in the event any emergency, such as a motor vehicle accident includes a pregnant woman in cardiac arrest. Working as a team, between departments and disciplines was key to our success. 

This was a topic, which initially, no one wanted to discuss.  However, to give every mother the best chance of survival, and failing that, rescuing the neonate will only happen if we are well prepared.  The authors recommend development of interdisciplinary and interdepartmental teams to develop maternal resuscitation and perimortem c-section policies, equipment and training utilizing simulations.