Liver lacerations as a complication of CPR during pregnancy.

AIM: Cardiac arrest in peripartum patients is a rare but devastating event; reported rates in the literature range from 0.019% to 0.0085%. In the general population, a well-described complication of cardiopulmonary resuscitation (CPR), liver laceration and injury, is reported at a rate of between 0.5-2.9% after CPR. Liver laceration rate among peripartum patients receiving CPR has not been well-studied. We sought to find the rate of liver lacerations in the peripartum population associated with CPR, with the hypothesis that the rate would be higher than in the general population.

METHODS: We identified pregnancies complicated by cardiac arrest by performing a retrospective medical record review from 2011 to 2016 at a single tertiary referral hospital. We then compared the rate of liver lacerations in this group to the rate in the general population as found in the literature.

RESULTS: Eleven of 9408 women in the peripartum period suffered cardiac arrest. Return of spontaneous circulation occurred in seven of eleven (64%) women. Three of these seven women suffered clinically significant liver laceration (43%). Overall mortality rate among women suffering cardiac arrest was 82% (9/11).Even after return of spontaneous circulation, the mortality rate was 72%(5/7) including two of three women suffering liver laceration.

CONCLUSIONS: Based on a small retrospective study, liver lacerations requiring intervention occurred in 43% of gravidas patients that survived CPR, and is significantly higher than published rates (0.6-2.1%) for the general patient population. Further studies are indicated to determine the incidence of liver injury after peripartum CPR.