Cesarean Section, Emergency

Basics

  • Emergent delivery in the setting of maternal cardiac arrest
  • Requires immediate recognition and initiation of resuscitation
  • Must quickly assess etiology to direct therapy
  • Rapid delivery offers the best chance for both maternal and fetal survival
  • Synonym: Resuscitative hysterotomy

ALERT
  • The sole indication for ED physician to perform emergency perimortem cesarean section is a gravid female (≥20-wk gestation) in cardiopulmonary arrest who has not responded to initial resuscitative measures, regardless of cause
  • The most important predictor of fetal survival is length of time between maternal cardiac arrest and cesarean delivery:
    • Cesarean section should begin within 4 min of maternal arrest
    • Goal is delivering fetus within 1 min
  • Obtain immediate consultations from obstetrics, pediatrics, and surgery, if trauma related:
    • Do not defer or delay performing procedure until arrival of consultants
  • Notify nearest NICU team if available
  • Do not perform emergent cesarean section if patient is <20-wk gestation

Etiology

  • Antepartum maternal cardiac arrest is rare:
    • 1/12,500 deliveries
  • Maternal survival is 17–59%
  • Fetal survival is 61–80%:
    • 88–100% of surviving infants are neurologically intact
  • Most common causes of maternal cardiac arrest:
    • Hemorrhage – 45%:
      • May be related to trauma
    • Amniotic fluid embolism – 13%
    • Sepsis – 11%
    • Anesthetic complications – 8%
    • Trauma – 3%

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