Perimortem Cesarean Section

Perimortem cesarean section must be considered as part of any resuscitation in the case of maternal cardiac arrest and a viable fetus. Prognosis for intact survival of the infant is excellent if delivery occurs within 5 min of maternal arrest and initiation of CPR. If the 5-min time frame has been exceeded, it is still recommended to perform a perimortem cesarean section. One case has been reported of a perimortem cesarean section performed 22 min after maternal cardiac arrest that resulted in a normal living infant.19 No cases have been reported of live births by perimortem cesarean section beyond 25 min after maternal arrest. Ideally, an obstetrician and a pediatrician or neonatologist are present at the time of a perimortem cesarean section. In the absence of these specialists, the emergency physician must be prepared to perform the procedure. It is not necessary and only delays a potentially lifesaving procedure to evaluate fetal viability prior to initiation of the cesarean section. For the same reasons, the patient should not be moved to an operating suite, since this only wastes time. The decision to perform a perimortem cesarean section should be made by 4 min after cardiac arrest, with delivery of the fetus by 5 min postarrest.

Maternal CPR should be continued throughout the procedure and for a brief time afterward, since a few cases of successful resuscitation following such a procedure have been reported. Necessary equipment includes a scalpel, bandage scissors, Mayo scissors, toothed forceps, Richardson retractors, needle drivers, and suture material (Table 12-4). The goal of this procedure is to remove and resuscitate the fetus.

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