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Maternal collapse: Challenging the four-minute rule.

M D Benson1, A Padovano2, G Bourjeily3

  • 1Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, NorthShore University Health System and Advocate Condell Medical Center, United States.

Ebiomedicine
|May 24, 2016
PubMed
Summary
This summary is machine-generated.

The "four-minute rule" for perimortem cesarean birth in pregnant women is not supported by evidence. Survival rates for mothers and neonates decrease with longer intervals from cardiac arrest to birth.

Keywords:
Cardiopulmonary resuscitation in pregnancyMaternal cardiac arrestMaternal mortalityPerimortem cesarean sectionPostmortem cesarean section

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Area of Science:

  • Emergency Medicine
  • Obstetrics & Gynecology
  • Perinatal Research

Background:

  • Current guidelines for cardiopulmonary resuscitation in third-trimester pregnant women follow the "four-minute rule."
  • This rule mandates cesarean birth if maternal pulses are not restored within 4 minutes of resuscitation initiation.
  • This study re-examines the evidence supporting the four-minute rule.

Purpose of the Study:

  • To evaluate the evidence behind the established "four-minute rule" for perimortem cesarean birth.
  • To determine the relationship between maternal arrest-to-birth intervals and maternal/neonatal survival rates.
  • To assess the feasibility of achieving birth within one minute of incision.

Main Methods:

  • A comprehensive literature review focused on perimortem cesarean births.
  • Analysis of maternal and neonatal injury-free survival rates based on arrest-to-birth intervals.
  • Determination of actual incision-to-birth intervals.

Main Results:

  • Maternal and neonatal injury-free survival rates declined progressively as the time from maternal arrest to birth increased.
  • No specific survival advantage or threshold was identified at the 4-minute mark.
  • Achieving birth within 1 minute of skin incision occurred in only 10% of cases.

Conclusions:

  • Care providers should proceed directly to cesarean birth during maternal cardiac arrest in the third trimester, without adhering to a 4-minute waiting period.
  • Immediate surgical intervention is recommended rather than waiting for maternal pulse restoration.
  • The goal should be expedited delivery, as achieving birth within 1 minute of incision is infrequent.