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Resuscitative hysterotomy

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
Pattaraporn T Chun, Ronald J McPherson, Luke C Marney, Sahar Z Zangeneh, Brendon A Parsons, Ali Shojaie, Robert E Synovec, Sandra E Juul
Biomarkers that indicate the severity of hypoxic-ischemic brain injury and response to treatment and that predict neurodevelopmental outcomes are urgently needed to improve the care of affected neonates. We hypothesize that sequentially obtained plasma metabolomes will provide indicators of brain injury and repair, allowing for the prediction of neurodevelopmental outcomes. A total of 33 Macaca nemestrina underwent 0, 15 or 18 min of in utero umbilical cord occlusion (UCO) to induce hypoxic-ischemic encephalopathy and were then delivered by hysterotomy, resuscitated and stabilized...
2015: Developmental Neuroscience
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
Richard Kaye, Elizabeth Shewry, Cliff Reid, Brian Burns
BACKGROUND: The Greater Sydney Area Helicopter Emergency Medical Service provides physicians for undertaking prehospital and inter-hospital critical care. We quantified the obstetric caseload of our service with respect to primary diagnosis and interventions in order to provide targeted physician training. MATERIALS AND METHODS: Retrieval records over a 4-year period were searched to identify keywords associated with pregnancy or obstetric complications. The data collected related to gestation, diagnosis, nature of transfer and interventions...
August 2014: Emergency Medicine Journal: EMJ
Ozgur Sogut, Atilla Kamaz, Mehmet Ozgur Erdogan, Yusuf Sezen
UNLABELLED: The management of cardiac arrest in pregnancy is an important task for the emergency physicians. The clinical outcome of mother or fetus will often depend on the successful resuscitation of the first few minutes. Furthermore, the resuscitation team leader should consider the necessity of emergency hysterotomy (cesarean delivery) as soon as a pregnant woman develops cardiac arrest. We report a case of a 28-year-old pregnant woman who had a ventricular fibrillation cardiac arrest...
February 2010: Journal of Clinical Medicine Research
Elizabeth N Jacobson Misbe, Todd L Richards, Ronald J McPherson, Thomas M Burbacher, Sandra E Juul
Perinatal asphyxia is a leading cause of brain injury in neonates, occurring in 2-4 per 1,000 live births, and there are limited treatment options. Because of their similarity to humans, nonhuman primates are ideal for performing preclinical tests of safety and efficacy for neurotherapeutic interventions. We previously developed a primate model of acute perinatal asphyxia using 12-15 min of umbilical cord occlusion. Continuing this research, we have increased cord occlusion time from 15 to 18 min and extended neurodevelopmental follow-up to 9 months...
2011: Developmental Neuroscience
Anne Boat, Mohamed Mahmoud, Erik C Michelfelder, Erica Lin, Pornswan Ngamprasertwong, Beverly Schnell, Charles D Kurth, Timothy M Crombleholme, Senthilkumar Sadhasivam
OBJECTIVE: To lower the incidence and severity of fetal cardiovascular depression during maternal fetal surgery under general anesthesia. AIM: We hypothesized that supplemental intravenous anesthesia (SIVA) with propofol and remifentanil would lower the need for high-dose inhalational anesthesia and provide adequate maternal depth of anesthesia and uterine relaxation. SIVA technique would minimize prolonged fetal exposure to deep inhalational anesthetics and significant intraoperative fetal cardiovascular depression...
August 2010: Paediatric Anaesthesia
Sandra E Juul, Elizabeth Aylward, Todd Richards, Ronald J McPherson, John Kuratani, Thomas M Burbacher
Our objective was to establish a nonhuman primate model of perinatal asphyxia appropriate for preclinical evaluation of neuroprotective treatment strategies under conditions that closely resemble human neonatal emergencies, and to begin testing the safety and efficacy of erythropoietin neuroprotective treatment. Prior to delivery by hysterotomy, the umbilical cords of near term Macaca nemestrina (n = 8) were clamped for times ranging between 12 and 15 min. Animals received erythropoietin (5,000 U/kg/dose x 2 i...
2007: Developmental Neuroscience
Andreana Bütter, Ioana Bratu, Hélène Flageole, Jean-Martin Laberge, Lajos Kovacs, Daniel Faucher, Bruno Piedoboeuf
Fetal tracheal occlusion (TO) has been used to reverse the lung hypoplasia associated with congenital diaphragmatic hernia (CDH). However, TO has a detrimental effect on type II pneumocyte function and surfactant production. Previously, we have shown that in surgically created CDH lambs, TO improved markedly the response to resuscitation even though the lungs remain surfactant deficient. The goal of this investigation was to assess the effects of exogenous surfactant administered at birth to CDH lambs with or without fetal TO during 8 h of resuscitation...
October 2005: Pediatric Research
Holly L Hedrick, Alan W Flake, Timothy M Crombleholme, Lori J Howell, Mark P Johnson, R Douglas Wilson, N Scott Adzick
BACKGROUND: Indications for the ex utero intrapartum therapy (EXIT) procedure have expanded to include any fetal anomaly in which resuscitation of the neonate may be compromised. METHODS: We reviewed the medical records of 9 patients after resection of lung lesions during the EXIT procedure. RESULTS: The mean gestational age at EXIT procedure was 35.4 weeks. All lung masses maintained large sizes late into gestation with mean mass volume/head circumference ratio of 2...
June 2005: Journal of Pediatric Surgery
Megan E Probyn, Stuart B Hooper, Peter A Dargaville, Naomi McCallion, Kelly Crossley, Richard Harding, Colin J Morley
Positive end expiratory pressure (PEEP) is important for neonatal ventilation but is not considered in guidelines for resuscitation. Our aim was to investigate the effects of PEEP on cardiorespiratory parameters during resuscitation of very premature lambs delivered by hysterotomy at approximately 125 d gestation (term approximately 147 d). Before delivery, they were intubated and lung fluid was drained. Immediately after delivery, they were ventilated with a Dräger Babylog plus ventilator in volume guarantee mode with a tidal volume of 5 mL/kg...
August 2004: Pediatric Research
Laura B Myers, Linda A Bulich, Philip Hess, Nicola M Miller
Fetal intervention for certain life-threatening conditions has progressed from being primarily experimental in nature to the standard of care in certain circumstances. While surgical techniques have advanced over the past few years, the anaesthetic goals for these interventions have remained the same; namely, minimizing maternal and fetal risk as well as maximizing the chances of a successful fetal intervention and optimize the conditions necessary to carry the fetus to term gestation. Fetal endoscopic techniques allow access to the fetus without the need for a hysterotomy incision, thus improving the chances of controlled post-operative tocolysis and term gestation after fetal intervention...
June 2004: Best Practice & Research. Clinical Anaesthesiology
F Xu, T F Fok, J Yin
OBJECTIVE: To provide suitable animal model (hyperoxia-induced premature rat lung damage) for research of bronchopulmonary dysplasia (BPD) and to better understand pathogenesis of BPD and look for effective drugs to prevent and treat BPD. METHODS: Rat litters delivered prematurely at 21-day gestation by hysterotomy. Vigorous resuscitation at birth resulted in a high survival rate. Surfactant and antioxidant enzyme (AOE) system were measured. The model was tested in an experiment of hyperoxia-induced lung injury...
July 1998: Chinese Medical Journal
W D Tavernor, P C Trexler, L C Vaughan, D G Jones
No abstract text is available yet for this article.
January 2, 1971: Veterinary Record
S D Cohle, C S Petty
A 16-year-old pregnant female presented to a hospital emergency room with vaginal bleeding and uterine cramping. She underwent a hysterotomy and curettage and, during the procedure, her pulse dropped from 130 to 30 beats/minute, her pO2 fell to 10 mm of mercury, and she could not be resuscitated. At autopsy, she was found to have massive pulmonary embolization of syncytiotrophoblast from a hydatidiform mole of the uterus. This is the sixth reported case of trophoblastic embolization from a hydatidiform mole ending in death...
October 1985: Journal of Forensic Sciences
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