Perimortem caesarean section – why, when and how

Abstract

Cardiac arrest in pregnancy is rare. Effective management involves the decision to perform a perimortem caesarean section if the gestation is greater than 20 weeks and return of spontaneous circulation does not occur after 4 minutes of effective cardiopulmonary resuscitation. Delivery should ideally be achieved within 5 minutes of cardiac arrest as this maximises maternal survival and reduces the risk of long-term neurological impairment.In hospital, the procedure should be undertaken at the site of the cardiac arrest without moving to an operating theatre. Minimal equipment is required to undertake the procedure. Clinical areas where pregnant women are seen should have a designated 'equipment box'. Debriefing all personnel is of utmost importance after the acute event. Learning objectivesTo understand why perimortem caesarean section is beneficial to maternal survival. To appreciate the need for rapid decision making when perimortem caesarean section is required. To gain practical knowledge of perimortem caesarean section, including the steps to be used when resuscitation is unsuccessful. Ethical issuesTo be aware that the primary aim of perimortem caesarean section is to aid maternal survival, not necessarily fetal survival.

The impact of cardiovascular diseases on maternal deaths in the Nordic countries

“…The perimortem cesarean sections (PMCS) were performed between 4 and 40 min after the cardiac arrest occurred, with only one PMCS performed within the recommended 5 min. 29 To maximize the chance of survival, the urgency with which the PMCS can be performed after the onset of the cardiac arrest is highly important, and it should be undertaken at the site of the cardiac arrest. This will only be possible if the cardiac arrest happens inside the hospital.…”

“…However, multidisciplinary team training has been shown to be effective in reducing the time interval from the initial arrest to PMCS and should be undertaken in all units where care for obstetric patients is provided. 29,30 Substandard care was prominent in more than half of the maternal cardiovascular deaths in the Nordic countries. Similar to the UK, 7 one-third of the cases were deemed potentially preventable with different care.…”

Untitled

“…Obstetricians should be aware of this terminology to ensure effective communication [82]. The gravid uterus impairs venous return and thus reduces cardiac output by approximately 60% secondary to aortocaval compression [83].…”

Maternal Collapse in Pregnancy and the Puerperium

“…The term ‘resuscitative hysterotomy’ has been introduced by non‐obstetric clinicians (for example, emergency medicine clinicians and paramedics) in the trauma and emergency department environments, as the procedure is primarily used to assist maternal resuscitation rather than to save the fetus. Obstetricians should be aware of this terminology to ensure effective communication . The gravid uterus impairs venous return and thus reduces cardiac output by approximately 60% secondary to aortocaval compression .…”

“…Obstetricians should be aware of this terminology to ensure effective communication. 82 The gravid uterus impairs venous return and thus reduces cardiac output by approximately 60% secondary to aortocaval compression. 83 chest wall.…”