Cesarean Section, Emergency
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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%
- Hemorrhage – 45%:
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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%
- Hemorrhage – 45%:
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