Cesarean delivery is a surgical procedure of delivering an infant from a pregnant woman through an incision on her abdomen and uterus.
Perimortem cesarean delivery is a life-saving surgical surgery done on a pregnant woman who is in cardiac arrest.
- Perimortem cesarean delivery is usually done after performing cardiac resuscitation on the mother.
- However, through the years, doctors have recognized that early perimortem cesarean delivery while providing cardiac resuscitation to the mother can reduce mortality in both the mother and infant.
- Newborns may need resuscitation because they may go into cardiac arrest.
Therefore, perimortem cesarean delivery is currently recognized as a genuine medical technique during maternal cardiac arrest resuscitation to increase maternal survival and rescue the infant.
How and when is perimortem cesarean delivery done?
To perform a perimortem cesarean delivery, the gestation period should be about 20 weeks when the fetus is estimated to be viable. Perimortem cesarean delivery is unlikely to be advantageous to the mother’s survival when maternal cardiac arrest occurs early in pregnancy because the fetal-placental mass is small, and its removal is less useful for maternal hemodynamics.
- The best time to perform a perimortem cesarean delivery is within the first five minutes of cardiac arrest because it increases the chances of survival of the infant and mother.
- If the gestation period of the mother is uncertain, clinical evaluation of gestation is to be done to proceed with perimortem cesarean delivery.
- The uterus will be 3 to 4 cm above the umbilicus.
The evaluation of pregnant women must be completed quickly to pinpoint the time of the loss of circulation. Monitoring vital signs is an important element of the examination. If time and resuscitation efforts allow, fetal tocometry should be started right away. A vertical incision is performed from the xiphoid to the pubis, followed by a vertical incision in the uterus to deliver the baby.
- Cardiopulmonary resuscitation is less effective in pregnant women in their third trimester because the enlarged uterus compromises cardiac output.
- The fetus in the uterus partially limits blood flow from a major vein called the vena cava, making it more difficult to pump enough blood through the mother’s body to keep her brain functioning properly.
- Perimortem cesarean delivery when done immediately after a cardiac arrest will redirect the flow of blood from the placenta, relieve pressure from the inferior vena cava, and improve ventilation of the mother, which increases the chances of maternal survival.
Perimortem cesarean delivery is conducted in a stressful, unknown circumstance with a collapsed mother, with no analgesia, continued cardiac compressions, and often in an unfamiliar place without access to suitable equipment and support. The result of a cardiac arrest resuscitation effort is determined by the underlying cause of the event as well as the success of the first resuscitation.
Resuscitation after maternal cardiac arrest
According to the American Heart Association's 2005 recommendations, the resuscitation leader should assess the requirement for an emergency hysterotomy (cesarean delivery) protocol as soon as a pregnant woman suffers cardiac arrest.
Even if delivery cannot be completed in five minutes, doing so as quickly as possible will typically offer the mother benefit and may result in a healthy fetus. The underlying etiology of the cardiac arrest, as well as the degree and length of maternal and fetal impairment before the event, will all affect the outcome.
- In the presence of high spinal anesthesia, resuscitation might be exceedingly challenging.
- Severe sympathectomy causes significant dilatation and blocking of the nerves T1 to T4, which has a significant impact on venous return and cardiac output.
- When aortocaval compression caused by the gravid uterus is paired with the low cardiac output situation achieved by cardiopulmonary resuscitation (CPR), there may be little or no venous return or cardiac output until birth.
With the loss of cardiac output, the mother may often have neurological impairment.
Although transferring the person to an operation theater for the procedure to be done is required, it may lead to loss of time and reduce the chances of survival of the mother and infant. Therefore, both resuscitation and perimortem cesarean delivery are done in nonoperating locations or circumstances.
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How common is maternal cardiac arrest?
Because a cardiopulmonary arrest is an uncommon occurrence during pregnancy and labor, perimortem cesarean deliveries were seldom performed in the past. However, the number of cardiac arrests has grown in recent years.
Unfortunately, limitations in the knowledge of this procedure are common.
- Mock exercises in CPR should be performed on a regular basis, and perimortem cesarean delivery should be included in training sessions.
- Because this is a difficult and distressing situation, all personnel involved in perimortem cesarean delivery should be debriefed.
Perimortem cesarean delivery history
- Perimortem cesarean delivery was one of the oldest surgical procedures that was first conducted in Roman times as a religious ceremony to preserve the child from the womb of a dead mother.
- Unanticipated advantages of newborn or maternal survival were only discovered centuries later.
- Maternal recovery and newborn survival following perimortem cesarean delivery were publicly recorded in the late 19th and early 20th centuries.
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Perimortem Cesarean: https://www.ncbi.nlm.nih.gov/books/NBK459265/
Perimortem Cesarean Delivery: https://emedicine.medscape.com/article/83059-overview
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