Key result
Pregnancy-related sudden death stems primarily from cardiac causes and yields only ~13% survival to admission.
Why the study?
Sudden death during pregnancy is a rare and poorly understood condition with devastating consequences, and its incidence, characteristics, and outcomes required determination.
Sudden death in pregnancy is an exceptionally rare but highly fatal event (0.98 cases per million women), with structural non-ischemic heart disease being the most frequent cardiovascular etiology.
Low survival with high fetal mortality warrants clinical awareness; extends incidence data on cardiac causes but leaves open targeted prevention.
Background Sudden Death (SD) during pregnancy is a rare and poorly understood condition that, nevertheless, has profoundly devastating consequences for families. Purpose We aimed to determine the incidence, characteristics and outcomes of SCA occurring in pregnant women. Methods All cases of SD occurring during pregnancy, delivery or early post-partum (up to 42 days) were collected from The LancetCommission Research Consortium on SD, including both resuscitated and non-resuscitated cases. Cohorts with exhaustive case collection were used to estimate the incidence among women of childbearing age (18-59 years). Results Overall, 291 cases were collected (mean age 32±6 yo). Most occurred during pregnancy (70.7%), compared to 9.6% during delivery and 19.6% in the early post-partum period. Estimated incidence was 0.98 cases [95%CI 0.80–1.30] per million women, leading to less than 25 cases across Europe per year. The majority of cases (56.7%) involved women with no prior history of cardiovascular disease or any risk factor, and most events took place during the day (62.3%), at home (65.0%), in presence of witness (81.4%). The cause of SD was established in 75%: cardiovascular causes accounted for 50.2% (N=108), while non-cardiovascular accounted for the remaining (49.8%). The most frequent cardiovascular etiologies were structural non-ischemic heart disease (50.0%, N=54), followed by ischemic (24.1%, N=26) and vascular causes (18.5%). Electrical heart diseases were diagnosed in 4 women out of 108 with a cardiac cause (3.7%). Most frequent non cardiac etiologies were obstetric-related (17.3%) and pulmonary embolism (13.3%). In most cases, the event resulted in fetal death (70.3%) regardless of pregnancy term. Causes remained unknown in 74 women (25.6% of all cases), including 40 cases for which no diagnosis could be established after autopsy (17.8%). Survival to hospital admission was 12.5%. Conclusion Our findings confirm the exceptional and highly severe nature of this condition. In many cases the etiology remains undiagnosed and non-cardiovascular causes may play a significant role.
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Weizman et al. (2025) studied this question. Pregnancy-related sudden death occurs at 0.98 per million women, with 50.2% cardiac causes and 70.3% fetal deaths; survival to hospital admission is 12.5%.
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