产妇心脏骤停期间剖宫产病例系列:我们的初步经验和审计

M. Kaur, R. Jain, Aayush Gulati, Ashima Taneja, Sahil Sardana, A. Grewal
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引用次数: 0

摘要

妊娠期心脏骤停是一种罕见的灾难性疾病,可导致母亲和婴儿的主要发病率和死亡率。考虑到产妇解剖和生理的改变,胎儿的存在,以及迫切需要分娩以优化产妇和胎儿的结局,需要采取及时的高质量复苏措施。因此,重要的是,卫生保健机构制定适当的系统,与最新的心肺复苏(CPR)建议相一致,为这一特殊群体的产妇。尽管有协议和训练,临床场景往往是情感上的压倒性的,并带来了巨大的认知负荷,复苏两个生命,同时进行剖宫产(PMCD)或复苏子宫切除术。我们报告5例产妇心脏骤停转到我们的三级护理医院,其中PMCD是正在进行的高质量CPR与手动左子宫移位的一部分。两位母亲有自发循环恢复(ROSC),而三位母亲则没有。一名新生儿的外貌、脉搏、鬼脸、活动和呼吸(APGAR)评分为8分。4名新生儿需要心肺复苏术,其中2名达到ROSC。病因主要为严重失血性休克、子痫、严重先兆子痫及过敏反应。在我们根据指南建立母体蓝色代码机制的初步经验中,较低的存活率反映了需要加强早期PMCD,使用认知辅助工具,并通过模拟演习和模拟进行再培训,以获得更好的未来结果。此外,认识到外围医院产科警告标志的变化是至关重要的,以便及时转诊到三级保健中心,有助于挽救宝贵的生命。
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Case series of perimortem caesarean delivery during maternal cardiac arrest: Our initial experience and audit
Cardiac arrest in pregnancy is a rare, catastrophic condition that can lead to major morbidity and mortality for both mother and baby. Prompt high-quality resuscitative measures need to be employed keeping in mind the altered maternal anatomy and physiology, presence of a compromised fetus, and an urgent need to deliver the baby for optimizing maternal and fetal outcomes. Therefore, it is important that health care facilities make appropriate systems in consonance with the latest recommendations of cardiopulmonary resuscitation (CPR) for this special group of parturients. Despite protocols and training, the clinical scenario often is emotionally overwhelming and brings forth an enormous cognitive load of resuscitating two lives along with the performance of perimortem cesarean delivery (PMCD) or resuscitative hysterotomy. We report five cases of maternal cardiac arrest referred to our tertiary care hospital, wherein PMCD was performed as part of ongoing high-quality CPR with manual left uterine displacement. Two mothers had a return of spontaneous circulation (ROSC), whereas ROSC could not be achieved in three. One neonate had an Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score of 8. Four neonates needed CPR, and ROSC was achieved in two of these. Underlying causes were mainly severe hemorrhagic shock, eclampsia, severe pre-eclampsia, and anaphylactic reactions. Poor survival rates in our initial experience of setting up a maternal code blue mechanism as per the guidelines reflect the need for reinforcement of early PMCD, use of cognitive aids, and retraining using mock drills and simulation for better outcomes in the future. In addition, awareness of modified obstetric warning signs in peripheral hospitals is essential so that timely referral to tertiary care centers can help salvage precious lives.
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来源期刊
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发文量
37
审稿时长
29 weeks
期刊最新文献
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