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Peri-mortem caesarean section after traumatic arrest: Crisis resource management
Wei Ming Ng1, Wei Feng Lee1, Si Oon Cheah1
1Emergency Department, Ng Teng Fong General Hospital, Singapore.
The American Journal of Emergency Medicine
|October 3, 2018
Summary
Peri-mortem caesarean section (PMCS) can save a fetus after maternal cardiorespiratory arrest. Emergency physicians can perform this rare procedure, as demonstrated by a case resulting in fetal survival despite maternal death.
Area of Science:
- Emergency Medicine
- Obstetrics
- Neonatal Resuscitation
Background:
- Peri-mortem caesarean section (PMCS) is a rare, life-saving procedure for fetuses following maternal cardiorespiratory arrest.
- Non-obstetricians, such as Emergency Physicians (EPs), frequently perform PMCS in emergent, resource-limited settings.
Observation:
- A 25-year-old pregnant female sustained traumatic cardiorespiratory arrest for 27 minutes after a motor vehicle crash.
- The Emergency Physician (EP) performed a timely PMCS within 3-4 minutes of arrival to the Emergency Department (ED).
- The neonate required resuscitation but survived and thrived, while the mother succumbed to her injuries.
Findings:
- Successful fetal survival following a PMCS performed by an Emergency Physician in a trauma-induced cardiorespiratory arrest scenario.
- The neonate received immediate resuscitation, umbilical vein access, and measures to prevent hypothermia, leading to survival.
- The case highlights the critical timing and multidisciplinary approach required for successful PMCS.
Implications:
- Demonstrates the feasibility and potential success of PMCS performed by EPs in emergency settings.
- Underscores the importance of prompt recognition and intervention for improving perinatal outcomes in maternal arrest.
- Suggests a need for standardized protocols and training for EPs performing PMCS to enhance maternal-fetal survival rates.
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