Abstract
BackgroundAlthough rare, cardiac arrest during pregnancy is the leading cause of maternal death. Recently, its incidence has been increasing worldwide because more pregnant women have risk factors. The provision of early, high-quality cardiopulmonary resuscitation (CPR) plays a major role in the increased likelihood of survival; therefore, it is important for clinicians to know how to manage it. Due to the aortocaval compression caused by the gravid uterus, clinical guidelines often emphasise the importance of maternal positioning during CPR, but there has been little evidence regarding which position is most effective.MethodsWe searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and OpenGrey (updated on April 3, 2021). We included clinical trials and observational studies with reported outcomes related to successful resuscitations.ResultsWe included eight studies from the 1,490 screened. The eight studies were simulation-based, crossover trials that examine the quality of chest compressions. No data were available about the survival rates of mothers or foetuses/neonates. The meta-analyses showed that resuscitation of pregnant women in the 27°–30° left-lateral tilt position resulted in lower quality chest compressions. The difference is an 19% and 9% reduction in correct compression depth rate and correct hand position rate, respectively, compared with resuscitations in the supine position. Inexperienced clinicians find it difficult to perform chest compressions in the left-lateral tilt position.ConclusionsGiven that manual left uterine displacement allows the patient to remain supine, the resuscitation of women in the supine position using manual left uterine displacement should continue to be supported. Further research is needed to fill knowledge gaps regarding the effects of maternal positioning on clinical outcomes, such as survival rates following maternal cardiac arrest.
Highlights
Cardiac arrest during pregnancy is rare but life-threatening and involves the lives of two patients: the mother and the fetus [1]
We identified no additional articles from the reference lists of the included studies or review articles, and of the 79 articles that underwent full-text evaluation, we excluded 71 for the reasons stated in the PRISMA flowchart (Figure 1)
One crossover Randomised Controlled Trial (RCT) examined the optimal methods for producing lateral tilt [45], and one nonrandomised crossover study [47] examined the effect of chest compression at various angles between 0° and 90° of inclination
Summary
Cardiac arrest during pregnancy is rare but life-threatening and involves the lives of two patients: the mother and the fetus [1]. Nationwide population-based studies from the United States, Canada, the United Kingdom and the Netherlands indicate the incidence of maternal cardiac arrest during pregnancy is approximately 1 in 12,000 to 1 in 36,000 [2,3,4,5]. Enomoto et al BMC Pregnancy and Childbirth (2022) 22:159 cardiac arrest and related maternal mortality have increased in several countries over the past 30 years [3, 6, 7]. This increase could be explained partially by more women with risk factors (rising maternal age, obesity and preexisting chronic medical conditions) becoming pregnant [7, 8]. Due to the aortocaval compression caused by the gravid uterus, clinical guidelines often emphasise the importance of maternal positioning during CPR, but there has been little evidence regarding which position is most effective
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