The word “perimortem” stands for at or near the time of death. So, as the name suggests, perimortem Cesarean refers to an emergency surgical delivery of the baby performed on a pregnant woman during or near her death.
It is an anxiety-provoking surgery considering the high risk associated with the condition. The mother may experience a cardiac arrest close to the child’s birth or may be at risk of developing a cardiac arrest.
The main goal of perimortem Cesarean include:
- Increase the chance of bringing consciousness of the mother
- Improve maternal survival
- Improve fetal survival
Perimortem Cesarean was initially performed as a religious ritual in Roman times to save the child from a dying mother’s womb. Centuries later, perimortem Cesarean section was accepted as a medical intervention.
Why is perimortem Cesarean important?
Perimortem Cesarean should be initiated within four minutes of cardiac arrest in a pregnant woman above 24 weeks of pregnancy for the following reasons:
- Relieving pressure on the mother’s heart caused by the uterus
- To increase the mother’s cardiac output
- Decrease oxygen demand
- Improve lung functioning because the diaphragm is lowered after the procedure
- Improve fetal and mother’s survival rate
- Improve ventilation
- Redirect blood flow from the placenta
It is the final resort to save a mother’s and child’s life and should be performed by experienced hands.
Perimortem Cesarean section is contraindicated in pregnant women under the following conditions:
- Pregnancy term of fewer than 24 weeks
- Return of immediate blood flow after a revival procedure (resuscitation)
How is a perimortem Cesarean performed?
To perform a perimortem Cesarean, a physician follows these steps.
- The woman is made to lie down on the left side
- Incisions are made on the abdomen and the uterus
- The fetus is removed from the uterus
- After delivery, suction is carried out through the nose and then through the mouth
- The cord is clamped and cut
- The resuscitation procedure is carried out on the mother and the child
What is the survival rate of the mother and fetus after a perimortem Cesarean section?
According to various studies, a perimortem Cesarean section improves the survival rates of the mother and baby.
Number of participants
used for study
|Survival rate||Number of participants who received perimortem Cesarean section||Perimortem Cesarean section provided within four to five minutes, and the survival rate of neonates|
|-||17 to 59 percent||61 to 80 percent||-||-|
|38||52.6 percent||89.4 percent||38/38||
If provided within these timelines:
|94||54.3 percent||63.6 percent||76/94||
|66||57.6 percent||79.3 percent||49/66||
To summarize, the survival rate among mothers and neonates has seen improvement described by various studies. However, this success rate can be guaranteed only when an experienced and skilled surgeon performs the procedure.
What are the complications of perimortem Cesarean section?
Perimortem Cesarean section (PMCS) is rarely performed because pregnancy-related death rates have been declining rapidly.
Some of the complications associated with PMCS include:
- Bladder injury
- Injury to the fetus
- Excessive maternal bleeding
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Alexander AM, Sheraton M, Lobrano S. Perimortem Cesarean Delivery. [Updated 2021 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK534240/
Wu SH, Li RS, Hwu YM. Live birth after perimortem cesarean delivery in a 36-year-old out-of-hospital cardiac arrest nulliparous woman. Taiwan J Obstet Gynecol. 2019 Jan;58(1):43-45. https://www.sciencedirect.com/science/article/pii/S102845591830281X
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