Cardiac arrest risk during hospitalized delivery highest among females with DIC

1 in 9000 hospital deliveries had cardiac arrest, however almost 7 out of 10 of the mothers were able to leave the hospital, says an article published in Annals of Internal Medicine. 

Estimates of cardiac arrest during birth inform the development of evidence-based prevention measures for fatalities associated with pregnancy. Nicole Ford and colleagues carried out this study to look at the rate, maternal factors related to, and survival following cardiac arrest during delivery hospitalization.

Acute care hospitals in the United States from 2017 to 2019 were the focus of this retrospective cohort research. The National Inpatient Sample database comprised hospitalizations for deliveries among female patients who were 12 to 55 years old. The International Classification of Diseases, 10th Edition, Clinical Modification codes were used to identify hospitalizations for delivery, obstetric outcomes, underlying medical problems, cardiac arrest, and severe maternal complications. Based on discharge disposition, survival to hospital discharge was calculated.

The key findings of this study were:

The cardiac arrest rate among 10 921 784 hospital deliveries in the United States was 13.4 per 100,000. 

68.6% (95% CI, 63.2% to 74.0%) of the 1465 patients who had cardiac arrest lived to be discharged from the hospital. 

Those with preexisting medical issues, Medicare or Medicaid coverage, advanced age, non-Hispanic Black race, and cardiac arrest were more likely to experience them. 

The most frequent co-occurring diagnosis was acute respiratory distress syndrome (56.0% [CI, 50.2% to 61.7%]). 

Mechanical breathing was the most prevalent co-occurring procedure or intervention (53.2% [CI, 47.5% to 59.0%]). 

For co-occurring disseminated intravascular coagulation (DIC) without or with transfusion, the percentage of survival to hospital discharge after cardiac arrest was lower (50.0% [CI, 35.8% to 64.2%] or 54.3% [CI, 39.2% to 69.5%], respectively).

Cardiac arrests that happened outside of hospital deliveries were excluded. It is uncertain how soon after delivery or other maternal issues the arrest occurred. Statistics do not differentiate between causes of cardiac arrest in pregnant women, such as problems with pregnancy or other underlying reasons. In hospitalizations with co-occurring DIC, survival was at its lowest.

Reference: 

Ford, N. D., DeSisto, C. L., Galang, R. R., Kuklina, E. V., Sperling, L. S., & Ko, J. Y. (2023). Cardiac Arrest During Delivery Hospitalization. In Annals of Internal Medicine. American College of Physicians. https://doi.org/10.7326/m22-2750