Lesson 285: Cardiopulmonary Resuscitation During Pregnancy and Perimortem Cesarean Delivery

Registration Fee: $15.00
2.0 AMA PRA Category 1 Credits^TM
available until April 30, 2011

Review Date: March, 2010

Participants who do not possess a copy of Anesthesiology News can download and print the course material in an easy to read convenient  format.  Participants must reflect on the information presented, and then register to complete the exam and course evaluation online before the availability date listed above.  (CME credit is not valid past this date).  

Click on the link below to download and print the course material and post-test exam.  Register for the exam to enter your responses to receive CME credit.  There are ten questions in the examination and you must achieve a score of 80% or better to earn CME credit.  Following successful completion, your certificate will be immediately available online.  In addition, a historical record of  completed CME courses is maintained online in an individualized profile.  This includes copies of course certificates which can be printed at any time.

The registration fee for this course is $15.00

Physicians are provided with two opportunities to successfully complete the exam presented here. 

Software Requirements: Adobe Acrobat Reader and any standard Internet Browser.

The committee has identified the need for anesthesia practitioners to maintain skills involving extreme and emergent cases—including those involving cardiopulmonary resuscitation (CPR). One example of a rare, extreme case with anesthetic implications is emergency childbirth during maternal cardiac arrest.

CASE HISTORY

A 40-year-old woman pregnant with twins at 29 weeks gestation, gravida V, para III, was admitted with shortness of breath and dyspnea on exertion. Her history was significant for long-standing smoking, moderate obesity, obstructive sleep apnea, and chronic hypertension that was controlled by labetalol. Initial measurements of her vital signs included blood pressure, 180/110 mm Hg; pulse, 96 beats per minute; respiration, 19 breaths per minute; and oxygen saturation, 93% on room air. A physical examination revealed rhonchi and rales bilaterally in lower lung bases and 2+ edema in the lower extremities. Laboratory test results were remarkable for 3+ proteinuria. Arterial blood gases on room air revealed pH 7.45; PaO2 92 mm Hg; and PaCO2 33 mm Hg. Liver function tests and platelet counts were within normal ranges. An obstetric sonogram confirmed viable twins with fetal heart rates of 130 to 140 beats per minute.

The patient was diagnosed with chronic hypertension with superimposed preeclampsia. Initial management included supplemental oxygen, IV labetalol, and magnesium sulfate. A chest x-ray and chest computed tomography (CT) angiography were scheduled to rule out pulmonary embolism.

Approximately 2 hours after her arrival, the patient became acutely anxious, tachypneic, and cyanotic. Oxygen saturation was determined to be 80% with a non–rebreather mask. Within minutes, the patient underwent respiratory arrest and was found to have no pulse. A cardiac arrest code was activated.

LEARNING OBJECTIVES

At the end of this activity, the participant should be able to:

1. List the major causes of cardiopulmonary arrest during pregnancy.

2. Summarize maternal physiologic changes associated with pregnancy.

3. Discuss the effects of physiologic changes from pregnancy on maternal resuscitation.

4. Explain major differences in administering cardiopulmonary resuscitation between pregnant and non-pregnant patients.

5. Assess the indications for a perimortem cesarean delivery.

6. Discuss the beneficial effects of perimortem cesarean delivery on maternal resuscitation.

7. Recognize the most important predictor for fetal well-being after perimortem delivery.

8. Outline the clinical implications of lateral displacement of the uterus during maternal -resuscitation.

9. Describe the 4-minute rule for perimortem cesarean delivery.

10. Present a well-designed plan for resuscitation in the clinical scenario of maternal cardiac arrest.

TARGET AUDIENCE:  Anesthesiologists

Accreditation Statement

Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation: The Mount Sinai School of Medicine designates each educational activity for a maximum of 2 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

It is the policy of Mount Sinai School of Medicine to ensure objectivity, balance, independence, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices.

Disclosures

The authors, reviewer, and editor have no relationships with pharmaceutical companies or manufacturers of products to disclose. This educational activity may contain discussion of published and/or investigational uses of agents for the treatment of disease. Some uses of these agents have not been approved by the FDA. Please refer to the official prescribing information for each product for approved indications, contraindications, and warnings.

CONTACT INFORMATION

Questions regarding course content may be directed to Dr. Elizabeth Frost: ElzFrost@aol.com.

If you require technical assistance with completing this course, please contact Continuing Education Online Customer Service at 718-648-8080 or send e-mail to ceo.contact7@proceo.com.

CALL FOR WRITERS

If you would like to write a CME lesson in Anesthesiology News, please send an e-mail to Elizabeth A.M. Frost, MD, at ElzFrost@aol.com