Cesarean Section, Emergency

Cesarean Section, Emergency is a topic covered in the 5-Minute Emergency Consult.

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Basics

ALERT
  • The sole indication for ED physician to perform emergency perimortem cesarean section is a gravid female (>24 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
  • Do not perform emergent cesarean section if patient is <24 wk gestation

Etiology

  • Trauma (penetrating or blunt):
    • Major cause of maternal mortality
  • Pulmonary embolus:
    • Thromboembolism is most common cause of nontraumatic maternal mortality
  • Cerebral vascular accident
  • Amniotic fluid embolism
  • DIC
  • Placenta previa
  • Eclampsia
  • Miscellaneous medical disorders:
    • Asthma
    • CHF
    • MI
    • Drug overdose

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Basics

ALERT
  • The sole indication for ED physician to perform emergency perimortem cesarean section is a gravid female (>24 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
  • Do not perform emergent cesarean section if patient is <24 wk gestation

Etiology

  • Trauma (penetrating or blunt):
    • Major cause of maternal mortality
  • Pulmonary embolus:
    • Thromboembolism is most common cause of nontraumatic maternal mortality
  • Cerebral vascular accident
  • Amniotic fluid embolism
  • DIC
  • Placenta previa
  • Eclampsia
  • Miscellaneous medical disorders:
    • Asthma
    • CHF
    • MI
    • Drug overdose

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