medigraphic.com
ISSN 2448-8909 (Print)

2012, Number 4

<< Back Next >>

Med Crit 2012; 26 (4)

Perimortem c-section and fetal maternal resuscitation in the emergency department: case report and review of the literature

Urrego JLA, Cárdenas CDP, Velázquez VJF, Archila LA, Perdomo AMA, Muñoz RDA, Campuzano HC, Castillo BS

Language: Spanish
References: 21
Page: 247-250
PDF size: 62.46 Kb.


ABSTRACT

The perimortem cesarean is an emerging procedure, with easy surgical technique and short duration that can be done by medical personnel not obstetrician with a basic training and which aims to improve maternal perfusion, often becoming a saving measure for both mother fetal or for one of the two, as discussed in the literature that support this review.
Case: 16 year old woman with 32 weeks of gestation was admitted with cardiac arrest and who after 2 minutes of unsuccessful resuscitation (8 min stop), was made a perimortem cesarean by a doctor in the emergency room, with excellent neurological outcome for the baby and later evidence of perfusion in the mother.
Review: There are reports with varying outcomes for the infant and mother after a perimortem cesarean. In 18 years we found 38 case reports in which was observed a good result in 89% of surviving infants, in 28% of them the operation was performed in the first 5 minutes and 98% had a good neurological status at 4 year follow-up, there are also acceptable results to the first 30 minutes after arrest.
Conclusion: The perimortem cesarean is an emergency procedure that is performed in a woman with more than 20 weeks gestation in extremis or cardiac arrest to improve venous return for a better resuscitation and try to save the mother and some cases only save the life of the fetus.


REFERENCES

  1. Karam M, Bustamante P, Campuzano M. Aspectos sociales de la mortalidad materna. Estudio de caso en el Estado de México. 2007. http://www.medicinasocial.info

  2. Mallampalli A, Powner DJ, Gardner MO. Cardiopulmonary resuscitation and somatic support of the pregnant patient. Crit Care Clin 2004;20:747–61.

  3. Morris S, Stacey M. Resuscitation in pregnancy. Br Med J 2003;327:1277–79.

  4. McDonnell NJ. Cardiopulmonary arrest in pregnancy: two case reports of successful outcomes in association with perimortem Caesarean delivery. British Journal of Anaesthesia 2009;103:406–9.

  5. NACER, Medellín–Colombia, 2010. Mortalidad neonatal en Medellín–Antioquia.

  6. Mattox K, Goetzl L. Trauma in pregnancy. Crit Care Med 2005;33:385-9.

  7. Katz V, Balderston K, DeFreest M. Perimortem Cesarean delivery: Were our assumptions correct? American Journal of Obstetrics and Gynecology 2005;192:1916–21.

  8. Vanden Hoek T, Morrison L, Shuster M, Cardiac Arrest in Special Situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122;S829-S861.

  9. Hazinski M F, Nadkarni V, Hickey R W. Part 10.8: Cardiac arrest associated with pregnancy. Circulation 2005;112:IV-150-IV-153.

  10. Whitten M, Irvine L. Postmortem and perimortem Cesarean section: what are the indications? J R Soc Med 2000;93:6–9.

  11. Vitsky M. Cesarean section on the dead and critically injured. Am J Obstet Gynecol 1964;90:17-24.

  12. Behney CA. Cesarean section delivery after death of mother. JAMA 1961;176:617-9.

  13. Strong T, Lowe R. Perimortem Cesarean section. American Journal of Emergency Medicine 1989;7:559-62.

  14. Vasco M. Resucitación cardiopulmonar en la embarazada. Rev Col de Anestesia 2004;32:243-5.

  15. Whitty J. Maternal cardiac arrest in pregnancy. Clinical Obstetrics and Gynecology 45(2):377-92.

  16. Confidential enquiries into maternal deaths in the UK, 1970-1996. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_4009520

  17. American Heart Association in collaboration with International Liaison Committee on Resuscitation. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science, Part 3: Adult Basic Life Support. Circulation 2000;102(Suppl l):22-59.

  18. Bowers W, Wagner C. Field Perimortem Cesarean section. Air Medical Journal 2001;20:10-11.

  19. Kue R, Coyle C, Vaughan E. Perimortem Cesarean section in the helicopter EMS setting: A case report. Air Medical Journal 2008;27:46-7.

  20. Lewis G. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mother’s Lives: Reviewing Maternal Deaths to Make Motherhood Safer 2003-2005. The Seventh Confidential Enquiry into Maternal Deaths in the United Kingdom. London: RCOG Press, 2007.

  21. Powner D, Bernstein I. Extended somatic support for pregnant women after brain death. Crit Care Med 2003;31:1241-9.




2020     |     www.medigraphic.com