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

Abstract

BackgroundDuring maternal cardiac arrest, emergency hysterotomy (EH) is recommended after four minutes of resuscitation, if no signs of spontaneous circulation are detected. This extreme procedure is believed to be potentially beneficial for both the mother and the infant. Both maternal and neonatal survivals seem to be associated to the time delay between the cardiac arrest and the delivery and in-hospital resuscitation location. In addition to this, gestational age is an important determinant to neonatal outcome.Case presentationWe report two emergency hysterotomies executed in an out-of-hospital location. The infants delivered by EH were low birth weight infants and born 20–23 min after maternal cardiac arrest. Both infants survived and had normal physical and neurological growth at the age of two years. Unfortunately, mothers in these both cases died in the field.ConclusionContrary to earlier beliefs, it is possible to perform a successful EH also in out-of-hospital setting, even with incomplete surgical skills. However, training and preparation are extremely important for achieving the highest possible readiness to treat maternal cardiac arrest situations also prehospitally.

Prehospital Management of Peripartum Neonatal Complications by Helicopter Emergency Medical Service in the South West of the Netherlands: An Observational Study

“…This is a specific group, and emergency resuscitative hysterotomy is the only chance for mother and child. [18][19][20] Considering the low incidence, performing a resuscitative hysterotomy is restricted to HEMS in our country.…”

Präklinische perimortale Crash-Sectio im Rahmen einer Traumareanimation

“…Zwei Fallberichte von Tommila et al. stellen ein Überleben ohne neurologischen Schaden zweier Neugeborener nach PPCS in der 30 + 4 und 26 + 5 SSW dar [ 17 ]. Woods beschreibt den Fall einer in der 30.…”

“…Als präklinische perimortale Crash-Sectio (PPCS) wird der perimortale Kaiserschnitt („perimortal cesarean section“ [PMCS]) im prähospitalen Setting bezeichnet. Das Überleben von Mutter und Kind nach präklinisch durchgeführter perimortaler Crash-Sectio ist auch nach prolongierter Versorgungszeit in der Literatur beschrieben [ 17 ]. Das Überleben nach präklinisch durchgeführter Traumareanimation, einschließlich Anwendung maximalinvasiver Interventionen, wird mit bis zu 12 % angegeben [ 16 ].…”