Gaps Found in Parturient Resuscitation Knowledge


PALM DESERT, CALF. — Obstetricians, emergency physicians, and anesthesiologists may suffer significant knowledge gaps when it comes to resuscitation of parturients, suggest survey results presented in poster form at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Faculty and residents in all three groups of specialists at Stanford (Calif.) University responded to an 11-question anonymous survey covering four critical knowledge areas concerning parturient resuscitation after catastrophic events leading to cardiorespiratory arrest:

▸ Awareness of the need for left uterine displacement.

▸ Recall of specific standard advanced cardiac life support (ACLS) algorithms.

▸ Knowledge of pertinent maternal physiology.

▸ Awareness of the recommendation to perform cesarean section in parturients at more than 20 weeks' gestation after 5 minutes of unsuccessful resuscitation for cardiac arrest.

Among 74 respondents, anesthesiologists answered the most questions correctly (average 76%). They were also better informed than other specialists about relevant maternal physiology.

Emergency physicians scored highest on questions regarding ACLS algorithms, averaging 93% correct responses.

All three groups earned similar scores on questions relating to left uterine displacement during resuscitation and the 5-minute cesarean rule. However, the rate of correct responses to those questions was low, at 60%–75%, said Leslie C. Andes, M.D., of the Stanford department of anesthesiology, and her associates.

They recommended that residents in all three specialties be required to complete ACLS certification, with an emphasis on the special resuscitation needs of parturients.

The issue may be of critical importance. Investigators pointed to findings in “Why Mothers Die 2000–2002,” a confidential analysis conducted in the United Kingdom that concluded some degree of substandard care was involved in more than 50% of maternal deaths and that most were preventable.

A lack of properly performed, timely resuscitation was implicated in some of those deaths.

“Catastrophic events leading to cardiorespiratory arrest may necessitate the resuscitation of pregnant women not only in labor and delivery suites, but also in other hospital locations,” Dr. Andes and her associates noted in the poster.

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