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Epidemiology of maternal cardiac arrest in Canada: A nationwide study
Abstract Number: BP-04
Abstract Type: Original Research
Introduction:Cardiac arrest during pregnancy is a rare event with an estimated incidence of 1:30,000 to 1:50,000 deliveries. Such events can be catastrophic,leading to a significant potential for major maternal and neonatal morbidity and mortality.
The objective of this study was to generate information about maternal cardiac arrest in Canada by examining the frequency, temporal incidence, associated conditions, maternal survival and fatality rates.
Methods: This retrospective cohort study was based on the hospitalization database for childbirth in Canada (except Quebec)from 2002/03 to 2013/14. The study population included women with gestational age 20 weeks and higher having cardiac arrest during hospitalization for childbirth. Cardiac arrest was defined based on ICD-10-CA diagnostic (I46.0, I46.1, I46.9, I49.00, I49.01) and intervention codes (1.HZ.30.^^, 1.HZ.09.JA-FS, 1.HZ.09.LA-FS, 1.HZ.09.LA-CJ). Data were summarized using descriptive statistics. Multivariable logistic regression analysis was used to identify medical and obstetrical conditions independently associated with maternal cardiac arrest.
Results: There were 261 cases of maternal cardiac arrest among 3,282,150 hospitalizations for delivery.185 women (70.9%, 95% CI 65.2% to 76.2%)survived to hospital discharge. The fatality rate was 28.8%. The frequency of cardiac arrest in 2002-2014 varied from 5 to 11 per 100,000 deliveries; there was no difference between the years (p=0.26). There was no variation in the incidence among Canadian provinces (p=0.42). Women who suffered cardiac arrest were more likely to be 35 yr and older (OR 2.34; 95% CI 1.69 to 3.26). Aortic aneurysm and dissection was the most common condition associated with maternal cardiac arrest, followed by obstetric embolism and heart failure. Table 1 lists statistically significant associations between maternal obstetric/ medical conditions, and cardiac arrest.
Discussion: This is the first Canadian population based cohort study on the epidemiology of maternal cardiac arrest. The event rate is 8:100,000 deliveries. Survival rate reported in this study is higher than previously reported, potentially owing to the differences in case identification between the studies. This information could be used to develop prospective database of the cases and guide development of the system approach in dealing with this condition.
1. Cantwell R et al. BJOG 2011; 118:1–203.
2. Dijkman A et al.BJOG 2010;117: 282–7.