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Perimortem cesarean delivery: were our assumptions correct?
Vern Katz1, Keith Balderston, Melissa DeFreest
1Department of Obstetrics/Gynecology, Sacred Heart Medical Center, Oregon Health Sciences University, Eugene, 97401, USA. vkatz@peacehealth.org
American Journal of Obstetrics and Gynecology
|June 23, 2005
Summary
Perimortem cesarean delivery (PMCD) outcomes were reviewed, finding that timely delivery may improve maternal and neonatal survival. While supporting the 4-minute guideline, data shows survival even with longer intervals, suggesting further research is needed.
Area of Science:
- Obstetrics and Gynecology
- Emergency Medicine
- Neonatalogy
Background:
- The 4-minute guideline for perimortem cesarean delivery (PMCD) after maternal cardiac arrest (MCA) assumes cardiopulmonary resuscitation (CPR) ineffectiveness due to aortocaval compression.
- This guideline aims to optimize maternal and fetal outcomes through rapid delivery.
Purpose of the Study:
- To review outcomes of perimortem cesarean deliveries.
- To validate assumptions regarding CPR effectiveness and the impact of delivery timing on maternal and neonatal survival.
Main Methods:
- Conducted Ovid MEDLINE searches (1985-2004) for terms including "maternal mortality," "cardiopulmonary resuscitation," "perimortem cesarean delivery," and "cardiac arrest."
- Reviewed bibliographies of identified articles and included case reports of complete maternal cardiopulmonary arrest with CPR initiated before delivery.
Main Results:
- 38 PMCD cases identified; 34 infants survived, with 4 later succumbing to prematurity/anoxia complications.
- Infant delivery times varied: 11 within 5 minutes, 4 (6-10 min), 2 (11-15 min), and 7 (>15 min).
- Maternal resuscitation occurred in 13 of 20 cases with potentially resuscitatable causes; 12 deliveries preceded maternal pulse return, with no maternal condition deterioration.
Conclusions:
- Published data over 20 years lend support, but do not definitively prove, that PMCD within 4 minutes improves maternal and neonatal outcomes.
- The findings suggest that timely PMCD is beneficial, but survival has been observed even with delivery intervals exceeding 4 minutes.