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
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%
- Hemorrhage – 45%:
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Citation
Schaider, Jeffrey J., et al., editors. "Cesarean Section, Emergency." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307371/all/Cesarean_Section_Emergency.
Cesarean Section, Emergency. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307371/all/Cesarean_Section_Emergency. Accessed October 4, 2024.
Cesarean Section, Emergency. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307371/all/Cesarean_Section_Emergency
Cesarean Section, Emergency [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 October 04]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307371/all/Cesarean_Section_Emergency.
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