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perimortem arrest

Megan E Healy, Dana E Kozubal, Amanda E Horn, Gary M Vilke, Theodore C Chan, Jacob W Ufberg
BACKGROUND: Maternal resuscitation in the emergency department requires planning and special consideration of the physiologic changes of pregnancy. Perimortem cesarean delivery (PMCD) is a rare but potentially life-saving procedure for both mother and fetus. Emergency physicians should be aware of the procedure's indications and steps because it needs to be performed rapidly for the best possible outcomes. OBJECTIVE: We sought to review the approach to the critically ill pregnant patient in light of new expert guidelines, including indications for PMCD and procedural techniques...
August 2016: Journal of Emergency Medicine
M D Benson, A Padovano, G Bourjeily, Y Zhou
INTRODUCTION: The current approach to, cardiopulmonary resuscitation of pregnant women in the third trimester has been to adhere to the "four-minute rule": If pulses have not returned within 4min of the start of resuscitation, perform a cesarean birth so that birth occurs in the next minute. This investigation sought to re-examine the evidence for the four-minute rule. METHODS: A literature review focused on perimortem cesarean birth was performed using the same key words that were used in formulating the "four-minute rule...
April 2016: EBioMedicine
A J Eldridge, R Ford
Although cardiac arrest in pregnancy is rare, it is important that all individuals involved in the acute care of pregnant women are suitably trained, because the outcome for both mother and fetus can be affected by the management of the arrest. Perimortem caesarean delivery was first described in 715 BC. Initially the procedure was performed principally for religious or political reasons. Although the potential for fetal survival was proposed, it was rarely successful, probably because the delivery was delayed until maternal death was established...
August 2016: International Journal of Obstetric Anesthesia
Zofia Maria Piosik, Henrik Alstrøm, Anna Aabakke, Jens Svare
Perimortem caesarean section can be decisive for the outcome of a cardiac arrest in pregnancy for both mother and fetus. We describe a case story of the management of cardiac arrest in early labour where perimortem caesarean section proved to be life-saving for both mother and child. The child was delivered alive seven minutes after recorded cardiac arrest, and the mother had return of spontaneous circulation one minute after delivery. The mother recovered well with no serious sequelae to the resuscitation...
March 21, 2016: Ugeskrift for Laeger
Venu Jain, Radha Chari, Sharon Maslovitz, Dan Farine, Emmanuel Bujold, Robert Gagnon, Melanie Basso, Hayley Bos, Richard Brown, Stephanie Cooper, Katy Gouin, N Lynne McLeod, Savas Menticoglou, William Mundle, Christy Pylypjuk, Anne Roggensack, Frank Sanderson
OBJECTIVE: Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. The aim of this document is to provide the obstetric care provider with an evidence-based systematic approach to the pregnant trauma patient. OUTCOMES: Significant health and economic outcomes considered in comparing alternative practices...
June 2015: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Carl H Rose, Arij Faksh, Kyle D Traynor, Daniel Cabrera, Katherine W Arendt, Brian C Brost
Although perimortem delivery has been recorded in the medical literature for millennia, the procedural intent has evolved to the current fetocentric approach, predicating timing of delivery following maternal cardiopulmonary arrest to optimize neonatal outcome. We suggest a call to action to reinforce the concept that if the uterus is palpable at or above the umbilicus, preparations for delivery should be made simultaneous with initiation of maternal resuscitative efforts; if maternal condition is not rapidly reversible, hysterotomy with delivery should be performed regardless of fetal viability or elapsed time since arrest...
November 2015: American Journal of Obstetrics and Gynecology
H T Truong, R M Browning
Anaphylaxis during pregnancy is rare but life threatening to both mother and fetus. The anaesthetist may be unexpectedly faced with an obstructing airway, severe bronchospasm and cardiac arrest requiring perimortem caesarean delivery to relieve aortocaval compression. We present a case of anaphylaxis-induced hyperfibrinolysis, an infrequently discussed complication that could exacerbate postpartum haemorrhage and hamper resuscitative efforts.
May 2015: International Journal of Obstetric Anesthesia
Richard Parry, Tilo Asmussen, Jason E Smith
This review describes a simple approach to perimortem caesarean section (PMCS) that can be used by a doctor in the resuscitation room or prehospital environment when faced with a mother of more than 20 weeks gestation in cardiac arrest. It explores the indications for and contraindications to the procedure, the physiological rationale behind it, equipment needed, technical aspects of the procedure and reviews recent literature on maternal and fetal outcomes. Like other uncommon procedures such as emergency department thoracotomy, rehearsal and preparation for a PMCS is essential to give both mother and baby the best chance of survival...
March 2016: Emergency Medicine Journal: EMJ
Judith Aronsohn, Brett Danzer, Frank Overdyk, Adam Roseman
Cardiopulmonary arrest during pregnancy is a devastating event necessitating rapid intervention from experienced practitioners to reduce the incidence and severity of adverse maternal and fetal outcomes. Perimortem cesarean delivery is rarely performed within the recommended time frame to meet these goals. We describe a case of a successful perimortem cesarean delivery after the "4-minute rule" in a morbidly obese parturient with goiter and preeclampsia.
February 15, 2015: A & A Case Reports
Michael J Bannon, Candace L Savonen, Zachary J Hartley, Magen M Johnson, Carl J Schmidt
The development of new therapeutic strategies for the treatment of complex brain disorders such as drug addiction is likely to be advanced by a more complete understanding of the underlying molecular pathophysiology. Although the study of postmortem human brain represents a unique resource in this regard, it can be challenging to disentangle the relative contribution of chronic pathological processes versus perimortem events to the observed changes in gene expression. To begin to unravel this issue, we analyzed by quantitative PCR the midbrain expression of numerous candidate genes previously associated with cocaine abuse...
2015: PloS One
Francesca Gatti, Marco Spagnoli, Simone Maria Zerbi, Dario Colombo, Mario Landriscina, Fulvio Kette
The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early "separation" between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC) in the mother. This treatment, called Perimortem Cesarean Section (PMCS), is now termed as Resuscitative Hysterotomy (RH) to better address the issue of an early Cesarean section (C-section)...
2014: Case Reports in Emergency Medicine
Radha Pandian, Manisha Mathur, Deepak Mathur
Cardiac arrest in pregnancy is a rare but catastrophic obstetric emergency, with a quoted incidence of 1:20,000 pregnancies. Speedy multidisciplinary interventions are crucial for good maternal and foetal outcomes. A perimortem caesarean section (PMCS) initiated within 4 min of onset of cardiac arrest to minimise the effect of aortocaval compression on cardiopulmonary resuscitation (CPR) has been recommended as a key intervention, which is likely to improve survival of both mother and foetus. Sudden collapse is uncommon in pregnant women and their management is more challenging than in a non-pregnant patient...
April 2015: Archives of Gynecology and Obstetrics
Lior Drukker, Yael Hants, Einav Sharon, Hen Y Sela, Sorina Grisaru-Granovsky
Cardiopulmonary arrest is a rare event during pregnancy and labor. Perimortem cesarean section has been resorted to as a rare event since ancient times; however, greater awareness regarding this procedure within the medical community has only emerged in the past few decades. Current recommendations for maternal resuscitation include performance of the procedure after five minutes of unsuccessful cardiopulmonary resuscitation. If accomplished in a timely manner, perimortem cesarean section can result in fetal salvage and is also critical for maternal resuscitation...
October 2014: Acta Obstetricia et Gynecologica Scandinavica
Farida Jeejeebhoy, Rory Windrim
Cardiac arrest in pregnancy is a rare event in routine obstetric practice, but is increasing in frequency. Resuscitation of cardiac arrest is more complex for pregnant women because of a number of factors unique to pregnancy: the altered physiologic state induced by pregnancy; the requirement to consider both maternal and fetal issues during resuscitation; and the consequent possibility of perimortem caesarean section during resuscitation. These extra considerations create a unique clinical emergency and decision pathway requiring the co-ordinated response of medical, obstetric, and neonatal teams...
May 2014: Best Practice & Research. Clinical Obstetrics & Gynaecology
Annie-Laurie Auden
No abstract text is available yet for this article.
January 2014: Hastings Center Report
Stephen S Hanson
No abstract text is available yet for this article.
January 2014: Hastings Center Report
(no author information available yet)
No abstract text is available yet for this article.
January 2014: Hastings Center Report
R Saha
When a woman in late pregnancy has cardiac arrest and resuscitation fails, should an attempt be made to deliver the baby by Caesarean section? Many obstetricians would hesitate to operate in these circumstances for fear of delivery a baby who survives but shows profound neurological handicap. Obstetricians need to have a clear view on whether and when to operate in such cases. Here we report two cases of PMCD.
October 2007: Kathmandu University Medical Journal (KUMJ)
Leyla Baghirzada, Mrinalini Balki
PURPOSE: To review and report maternal and neonatal outcomes after cardiac arrest during pregnancy in a large tertiary care centre and to consider steps to improve the outcomes. CLINICAL FEATURES: We performed a retrospective chart review of maternal cardiac arrest in the Mount Sinai Hospital, University of Toronto health records database for the period 1989-2011. Five cases were identified for an incidence of 1:24,883 deliveries (0.004%). Four of the five women were obese and older than 35 yr...
November 2013: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Yoshihiro Moriwaki, Yoshio Tahara, Takayuki Kosuge, Noriyuki Suzuki
CONTEXT: The spectrum of the etiology of out-of-hospital cardiopulmonary arrest (OHCPA) has not been established. We have performed perimortem computed tomography (CT) during cardiopulmonary resuscitation. AIMS: To clarify the incidence of non-cardiac etiology (NCE), actual distribution of the causes of OHCPA via perimortem CT and its usefulness. SETTINGS AND DESIGN: Population-based observational case series study. MATERIALS AND METHODS: We reviewed the medical records of 1846 consecutive OHCPA cases and divided them into two groups: 370 showing an obvious cause of OHCPA with NCE (trauma, neck hanging, terminal stage of malignancy, and gastrointestinal bleeding) and others...
April 2013: Journal of Emergencies, Trauma, and Shock
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