Abstract 13677: Incidence and Survival to Hospital Discharge After Maternal Cardiac Arrest: A Systematic Review and Meta-Analysis

Abstract

Introduction: Maternal cardiac arrest (MCA) is considered a rare but devastating complication of pregnancy. However, the overall incidence, etiologies, and maternal and neonatal survival outcomes remain unknown. Research Question: What is the incidence of MCA? What are the underlying etiologies and survival to hospital discharge rate in women with MCA? Methods: Electronic databases PubMed, Embase, and Cochrane were searched from inception up to May 2023 for studies reporting the incidence, etiology, or outcomes of MCA (in-hospital or out-of-hospital cardiac arrest). Primary outcomes of interest were pooled incidence of MCA per 100,000 maternities and maternal survival to hospital discharge rate. Secondary outcomes of interest included frequency of underlying etiologies, perimortem cesarean section (PMCS) rate, and neonatal survival rate. A random-effects model meta-analysis was performed. Heterogeneity was assessed using I-squared test. Results: Eight studies surveying 63,859,400 maternities were included. Median (interquartile range) gestational age at the time of MCA was 32.03 (26.33-37.72) months. Pooled incidence of MCA was 5.83 (95% CI: 3.07-8.59) per 100,000 maternities (Figure 1A) . Rate of survival to hospital discharge after MCA was 42% (95% CI: 30-54) (Figure 1B) . Of the studies that reported etiologies, most common were maternal obstetric hemorrhage (30%; 95% CI: 16-43), cardiac etiology (20%; 95% CI: 11-28), amniotic fluid embolism (13%; 95% CI: 12-14) and venous thromboembolism (13%; 95% CI: 6-19). Incidence of PMCS was 36% (95% CI: 11-62) and neonatal survival rate in women with MCA was 45% (95% CI: 18-73). Conclusions: Less than half of the women with maternal cardiac arrest survived to hospital discharge and only 36% underwent perimortem cesarean section. The most common etiologies of MCA were maternal obstetric hemorrhage, cardiac etiology, amniotic fluid embolism and venous thromboembolism.