Perimortem cesarean section for maternal and fetal salvage: concise review and protocol

Abstract

Cardiopulmonary arrest is a rare event during pregnancy and labor. Perimortem cesarean section has been resorted to as a rare event since ancient times; however, greater awareness regarding this procedure within the medical community has only emerged in the past few decades. Current recommendations for maternal resuscitation include performance of the procedure after five minutes of unsuccessful cardiopulmonary resuscitation. If accomplished in a timely manner, perimortem cesarean section can result in fetal salvage and is also critical for maternal resuscitation. Nevertheless, deficits in knowledge about this procedure are common. We have reviewed publications on perimortem cesarean section and present the most recent evidence on this topic, as well as recommending our "easy-to-access protocol" adapted for resuscitation following maternal collapse.

Two cases of low birth weight infant survival by prehospital emergency hysterotomy

“…The science behind maternal resuscitation guidelines is understandably sparse, and based mainly on reviews, case reports and simulation based studies [3, 6–8]. The most important factors affecting maternal survival seem to be in-hospital location and emergency hysterotomy in less than 10 min [9].…”

“…However, these cases are not descriptions of an ideal performance of EH. At least a few meritious papers [2, 8, 17] have reviewed earlier literature and published recommendations for how to perform an EH.…”

“…For example, the first EH was performed with a vertical incision, when a horizontal incision was used for the second EH. Both incision strategies lead to a similar result, but the literature suggests a vertical midline laparotomy incision might be better for emergency situations [2, 8, 17] in order to maximize exposure and make the procedure as easy as possible. A beforehand preparation could make procedure more structured and diminish variation between different operators.…”

Maternal Collapse in Pregnancy and the Puerperium

“…Time should not be wasted by moving the woman to an operating theatre; a PMCS can be performed anywhere, with a scalpel being the only essential equipment required. 86,87 With no circulation, blood loss is minimal, and no anaesthetic is required. If resuscitation is successful following birth, there should be prompt transfer to an appropriate environment at that point, as well as anaesthesia and sedation, to control ensuing haemorrhage and complete the operation.…”

“…However, many will be unfamiliar with this approach and as delivery can be achieved rapidly with a transverse approach, the operator should use the approach they are most comfortable with. 86 Manual uterine displacement can be stopped immediately prior to incision. If resuscitation is successful, the uterus and abdomen should be closed in the usual way to control blood loss and minimise the risk of infection.…”