“…In general, poor care occurred before cardiac arrest with 92 (79%) of 117 ratings of poor care occurring in the phase before cardiac arrest [4]. In obstetric cases of cardiac arrest, care before cardiac arrest was rated poor in 18% with elements of poor care in 25% [1], compared with vascular surgery (10% and 34%, respectively) [5] and in all cases (10% and 31%, respectively). Overall care in obstetric patients was rated good in 53% and poor in none.…”