Chapter 45
Perimortem cesarean section
Christian Martin-Gill,
Christian Martin-Gill
Search for more papers by this authorChristian Martin-Gill,
Christian Martin-Gill
Search for more papers by this authorBook Editor(s):David C. Cone MD,
Jane H. Brice MD, MPH,
Theodore R. Delbridge MD, MPH,
J. Brent Myers MD, MPH,
David C. Cone MD
Professor of Emergency Medicine
Yale University School of Medicine, New Haven, Connecticut
Search for more papers by this authorJane H. Brice MD, MPH
Professor of Emergency Medicine
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Search for more papers by this authorTheodore R. Delbridge MD, MPH
Executive Director
Maryland Institute for Emergency Medical Services Systems, Baltimore, Maryland
Search for more papers by this authorJ. Brent Myers MD, MPH
Chief Medical Officer ESO Associate Medical Director
Wake County EMS, Raleigh, North Carolina
Search for more papers by this authorFirst published: 18 August 2021
Summary
The management of a pregnant patient in cardiac arrest encountered in the out-of-hospital setting is a challenging event with two patients to consider, the mother and fetus. Perimortem cesarean section is a recommended component of maternal resuscitation for pregnant patients after 20-24 weeks of gestation as a means of facilitating survival of both the baby and mother. This chapter discusses the potential benefits and indications for perimortem C-section. Prior case reports and case series in the medical literature are reviewed, and challenges of performing perimortem C-section in the field are discussed. A description of the procedure provides detailed instruction, including the equipment necessary to perform this procedure in the out-of-hospital setting. Ethical and legal considerations are also discussed. Through a review of the perimortem C-section and its performance in the field, EMS physicians will be better able to manage the out-of-hospital resuscitation of a pregnant patient in cardiac arrest.
References
- Fadel HE . Postmortem and perimortem cesarean section: historical, religious and ethical considerations . J IMA . 2011 ; 43 : 194 – 200 .
- Katz VL . Perimortem cesarean delivery: its role in maternal mortality . Semin Perinatol . 2012 ; 36 : 68 – 72 .
- Lanoix R , Akkapeddi V , Goldfeder B . Perimortem cesarean section: case reports and recommendations . Acad Emerg Med . 1995 ; 2 : 1063 – 7 .
- Katz V , Balderston K , DeFreest M . Perimortem cesarean delivery: were our assumptions correct? Am J Obstet Gynecol . 2005 ; 192 : 1916 – 20 ; discussion 20-1.
- Katz VL , Dotters DJ , Droegemueller W . Perimortem cesarean delivery . Obstet Gynecol . 1986 ; 68 : 571 – 6 .
- Guven S , Yazar A , Yakut K , Aydogan H , Erguven M , Avci E . Postmortem cesarean: report of our successful neonatal outcomes after severe trauma during pregnancy and review of the literature . J Matern Fetal Neonatal Med . 2012 ; 25 : 1102 – 4 .
- Engels PT , Caddy SC , Jiwa G , Douglas Matheson J . Cardiac arrest in pregnancy and perimortem cesarean delivery: case report and discussion . CJEM . 2011 ; 13 : 399 – 403 .
- Cardosi RJ , Porter KB . Cesarean delivery of twins during maternal cardiopulmonary arrest . Obstet Gynecol . 1998 ; 92 : 695 – 7 .
- Whitten M , Irvine LM . Postmortem and perimortem caesarean section: what are the indications? J R Soc Med . 2000 ; 93 : 6 – 9 .
- Page-Rodriguez A , Gonzalez-Sanchez JA . Perimortem cesarean section of twin pregnancy: case report and review of the literature . Acad Emerg Med . 1999 ; 6 : 1072 – 4 .
- Dijkman A , Huisman CM , Smit M , et al. Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency skills training? BJOG . 2010 ; 117 : 282 – 7 .
- Einav S , Kaufman N , Sela HY . Maternal cardiac arrest and perimortem caesarean delivery: evidence or expert-based? Resuscitation . 2012 ; 83 : 1191 – 200 .
- Gatti F , Spagnoli M , Zerbi SM , Colombo D , Landriscina M , Kette F . Out-of-Hospital perimortem Cesarean section as resuscitative hysterotomy in maternal posttraumatic cardiac arrest . Case Rep Emerg Med . 2014 ; 2014 : 121562 .
- Rose CH , Faksh A , Traynor KD , Cabrera D , Arendt KW , Brost BC . Challenging the 4- to 5-minute rule: from perimortem cesarean to resuscitative hysterotomy . Am J Obstet Gynecol . 2015 ; 213 : 653 – 6 , e1.
- Kupas DF , Harter SC , Vosk A . Out-of-hospital perimortem cesarean section . Prehosp Emerg Care . 1998 ; 2 : 206 – 8 .
- Bowers W , Wagner C . Field perimortem cesarean section . Air Med J . 2001 ; 20 : 10 – 1 .
- Kue R , Coyle C , Vaughan E , Restuccia M . Perimortem Cesarean section in the helicopter EMS setting: a case report . Air Med J . 2008 ; 27 : 46 – 7 .
- Lenz H , Stenseth LB , Meidell N , Heimdal HJ . Out-of-hospital perimortem Cesarean delivery performed in a woman at 32 weeks of gestation: a case report . A A Case Rep . 2017 ; 8 : 72 – 4 .
- Byhahn C , Bingold TM , Zwissler B , Maier M , Walcher F . Prehospital ultrasound detects pericardial tamponade in a pregnant victim of stabbing assault . Resuscitation . 2008 ; 76 : 146 – 8 .
- Woods M . Prehospital perimortem Caesarean section - a survivor . Prehosp Emerg Care . 2020 ; 24 : 595 – 9 .
- Tommila M , Pystynen M , Soukka H , Aydin F , Rantanen M . Two cases of low birth weight infant survival by prehospital emergency hysterotomy . Scand J Trauma Resusc Emerg Med . 2017 ; 25 : 62 .
- Kaye R , Shewry E , Reid C , Burns B . The obstetric caseload of a physician-based helicopter emergency medical service: case review and recommendations for retrieval physician training . Emerg Med J . 2014 ; 31 : 665 – 8 .
- Bloomer R , Reid C , Wheatley R . Prehospital resuscitative hysterotomy . Eur J Emerg Med . 2011 ; 18 : 241 – 2 .
- Brun PM , Chenaitia H , Dejesus I , Bessereau J , Bonello L , Pierre B . Ultrasound to perimortem caesarean delivery in prehospital settings . Injury . 2013 ; 44 : 151 – 2 .
- Chen DW . 2 Paramedics face inquiry over surgery in emergency . Available at: http://www.nytimes.com/1997/09/27/nyregion/2-paramedics-face-inquiry-over-surgery-in-emergency.html . Accessed August 8, 2020.
- Hauswald M , Kerr NL . Perimortem cesarean section . Acad Emerg Med . 2000 ; 7 : 726 .
- American College of Obstetricians and Gynecologists' Committee on Practice Bulletins . ACOG Practice Bulletin No. 211: Critical care in pregnancy . Obstet Gynecol . 2019 ; 133 : e303 – 19 .
- Gunevsel O , Yesil O , Ozturk TC , Cevik SE . Perimortem caesarean section following maternal gunshot wounds . J Res Med Sci . 2011 ; 16 : 1089 – 91 .
- Knobloch K. Re: Perimortem cesarean section in the helicopter EMS setting . Air Med J . 2008 ; 27 : 152 – 3 .
- McDonnell NJ . Cardiopulmonary arrest in pregnancy: two case reports of successful outcomes in association with perimortem Caesarean delivery . Br J Anaesth . 2009 ; 103 : 406 – 9 .
- Morris JA Jr. , Rosenbower TJ , Jurkovich GJ , et al. Infant survival after cesarean section for trauma . Ann Surg . 1996 ; 223 : 481 – 8 ; discussion 8–91.
- Phelan HA , Roller J , Minei JP . Perimortem cesarean section after utilization of surgeon-performed trauma ultrasound . J Trauma . 2008 ; 64 : E12 – 4 .
- Vanden Hoek TL , Morrison LJ , Shuster M , et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care . Circulation . 2010 ; 122 : S829 – 61 .
- Lavonas EJ , Drennan IR , Gabrielli A , et al. Part 10: Special circumstances of resuscitation: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care . Circulation . 2015 ; 132 : S501 – 18 .
- Awwad JT , Azar GB , Aouad AT , Raad J , Karam KS . Postmortem cesarean section following maternal blast injury: case report . J Trauma . 1994 ; 36 : 260 – 1 .
- Capobianco G , Balata A , Mannazzu MC , et al. Perimortem cesarean delivery 30 minutes after a laboring patient jumped from a fourth-floor window: baby survives and is normal at age 4 years . Am J Obstet Gynecol . 2008 ; 198 : e15 – 6 .
- Lopez-Zeno JA , Carlo WA , O'Grady JP , Fanaroff AA . Infant survival following delayed postmortem cesarean delivery . Obstet Gynecol . 1990 ; 76 : 991 – 2 .
- Jeejeebhoy FM , Zelop CM , Windrim R , Carvalho JC , Dorian P , Morrison LJ . Management of cardiac arrest in pregnancy: a systematic review . Resuscitation . 2011 ; 82 : 801 – 9 .
- Strong TH Jr. , Lowe RA . Perimortem cesarean section . Am J Emerg Med . 1989 ; 7 : 489 – 94 .
- Doan-Wiggins L. Chapter 57. Emergency childbirth . In: JR Roberts , JR Hedges , editors. Clinical Procedures in Emergency Medicine . 4th ed. Philadelphia, PA : W.B. Saunders , 2004 .
- Cunningham FG , Leveno KJ , Bloom SL , Hauth JC , Rouse DJ , Spong CY. Chapter 25. Cesarean Delivery and peripartum hysterectomy . In: FG Cunningham , KJ Leveno , SL Bloom , JC Hauth , DJ Rouse , CY Spong , editors. Williams Obstetrics . 23rd ed. New York : McGraw-Hill Medical , 2010 .
