Perimortem cesarean

Cardiac arrest after acute pulmonary edema in pregnancy is an uncommon event but one with a potentially disastrous outcome. We report the case of a pregnant woman with preeclampsia who presented with rapidly advancing pulmonary edema and subsequently went into cardiac arrest on arrival at the operating room. A perimortem cesarean section was performed in addition to cardiopulmonary resuscitation and anesthesia. These simultaneous treatments resulted in excellent maternal and neonatal outcomes. Moreover, therapeutic brain hypothermia was performed...

PURPOSE: To evaluate obstetric units (OUs) and intensive care units (ICUs) preparedness for severe maternal morbidity (SMM). METHODS: From September 2021 to January 2022, an international multicentre cross-sectional study surveyed OUs in 26 WHO Europe Region countries. We assessed modified early obstetric warning score usage (MEOWS), approaches to four SMM clinical scenarios, invasive monitoring availability in OUs, and access to high-dependency units (HDUs) and onsite ICUs...

In massive pulmonary embolism (PE), anticoagulation and thrombolytics may increase the risk of retroperitoneal bleeding following vascular cannulation for extracorporeal hemodynamic support resulting in abdominal compartment syndrome (ACS). A 27-year-old women at 33 weeks of gestation presented with acute chest pain and shortness of breath. Massive PE was diagnosed. Intravenous unfractionated heparin was started together with catheter-directed tissue plasminogen activator (tPA) infusion and mechanical thrombectomy...

Aortic dissection is the acute aortic syndrome with the highest mortality, and pregnancy and arterial hypertension are known risk factors. Its association with the perinatal period is a particularly unique and potentially devastating clinical catastrophe which is why the approach to a pregnant woman in cardiorespiratory arrest (CRA) should be multidisciplinary and early, with extraction of the fetus ideally within five minutes after the arrest. We present the case of a 39-year-old pregnant woman, who presented with a cardiorespiratory arrest in the context of an aortic dissection with cardiac tamponade and the need for an urgent perimortem cesarean section...

Perimortem cesarean delivery is an effective procedure for cardiopulmonary resuscitation during pregnancy. However, there are no reports documenting long-term outcomes in perimortem cesarean delivery survivors. This may be the first report of a successful live birth, occurring two years after perimortem cesarean delivery. A 29-year-old primipara was transferred to the emergency center on account of cardiopulmonary arrest, at 33 weeks of gestation. She was resuscitated 47 min after cardiopulmonary arrest by perimortem cesarean delivery amongst other treatment modalities, although the fetus died...

Trauma is the leading cause of nonobstetric maternal death. Pregnant patients have a similar spectrum of traumatic injuries with a noted increase in interpersonal violence. A structured approach to trauma evaluation and management is recommended with several guidelines expanding on ATLS principles; however, evidence is limited. Optimal management requires understanding of physiologic changes in pregnancy, a team-based approach, and preparation for interventions that may including neonatal resuscitation. The principles of trauma management are the same in pregnancy with a systematic approach and initial maternal focused resuscitation...

Maternal collapse is a rare, potentially fatal event with associated feto-maternal morbidity and mortality. We report a case of severe mitral stenosis without any prior symptoms, that presented as acute cardiac decompensation leading to maternal collapse and cardiac arrest. A 35-year-old female in her 28th week of gestation presented to the emergency room with a four-hour history of per-vaginal discharge and leaking of amniotic fluid. Her past history, physical examination, and laboratory workup were unremarkable...

A 9 yr old, unknown weight, intact female domestic shorthair presented for evaluation of dystocia with dyspnea. En route to the hospital for treatment, the owners noted the queen stopped breathing. On presentation, cardiopulmonary arrest was confirmed. The exact cause was unknown but suspected to be secondary to acute fulminant congestive heart failure or acute respiratory distress syndrome due to a large volume of serosanguineous fluid within the mouth and nose. Cardiopulmonary resuscitation (CPR) was immediately started...

INTRODUCTION: Cardiac arrest in pregnancy is a rare, yet extremely challenging condition to manage for all healthcare personnel involved. Knowledge deficits and poor resuscitation skills can affect outcomes in cardiac arrest in pregnancy, but research exploring healthcare personnel competence and knowledge about maternal resuscitation is limited. AIMS: The aim of this study was to explore (1) healthcare personnel self-assessed competence and knowledge about cardiopulmonary resuscitation (CPR) in pregnancy as well as perimortem caesarean section, before and after implementation of a new guideline, (2) whether there were any interprofessional differences in knowledge about maternal resuscitation, and (3) potential differences between different implementation strategies...

INTRODUCTION: Trauma during pregnancy is the leading cause of non-obstetric maternal death and complicates up to 5%-7% of pregnancies. This systematic review without meta-analysis explores the current literature regarding the assessment and management of pregnant trauma patients to provide evidence-based recommendations to guide the general surgeon regarding the prognostic value of laboratory testing including Kleihauer-Betke testing, duration of maternal and fetal monitoring, the use of tranexamic acid, the safety of radiographic studies, and the utility of perimortem cesarean section to improve maternal and fetal mortality...

Cesarean section via a transverse uterine fundal incision is performed in patients with placenta previa to reduce blood loss. We describe a case of uterine rupture in a pregnant woman who previously underwent a cesarean section and recovered from cardiac arrest by multidisciplinary management.

We report the successful salvage of mother and baby after a perimortem cesarean delivery (PMCD) complicated by a 21-minute asystolic maternal cardiac arrest (MCA) that was precipitated by a pulmonary embolism during the early stages of induction of labor. With rapid PMCD, recovery of maternal quality of life is possible even after prolonged resuscitation.

The following case report discusses the resuscitation of a pregnant woman in traumatic cardiac arrest after a fall from a height with consecutive resuscitative hysterotomy for maternal and fetal salvage. The report illustrates all lessons learned from critical appraisal amid new guideline recommendations and gives an overview of the published literature on the matter. Despite extensive resuscitation efforts, ultimately both the mother and the newborn were pronounced life extinct at the scene. Prehospital treatment of (traumatic) cardiac arrest in a pregnant patient as well as performing a perimortem cesarean section remain infrequent but challenging scenarios...

Resuscitative hysterotomy (RH) is a rare, time-sensitive, invasive procedure that can be frightening for emergency physicians and yet potentially life-saving for fetus and mother. Several low-cost RH task trainers have been described in the literature. We set out to construct a model using improved synthetic materials for the uterine and abdominal wall and to devise hemorrhage capability. The primary aim of this study was to evaluate the model's perceived usefulness of its features. Secondarily, we wished to assess the confidence of emergency medicine (EM) residents before and after performing a RH using our task trainer in a simulated environment...

The prevalence of cardiac arrest in pregnant women varies from 1/20,000 to 1/50,000 pregnancies and is associated with high fetomaternal mortality. The pregnant mother is more susceptible to cardiac arrest as hypoxia is poorly tolerated. Hemorrhage, eclampsia, sepsis, and embolism are common causes of arrest. Cardiac arrest is preventable if a predisposing clinical problem is detected in time by an early warning score and treated immediately. Resuscitation in obstetric patient is challenging and special as it involves the lives of two patients, the mother and the fetus...

PURPOSE: To objectively evaluate the methodological quality and clinical heterogeneity robustness of the published clinical practice guidelines (CPGs) on the management of trauma in pregnancy. MATERIALS AND METHODS: Pubmed, Google Scholar, UpToDate, and Scopus Database were searched. The risk of bias and quality assessment of the included CPGs were performed using "The Appraisal Of Guidelines for Research and Evaluation (AGREE II)" tool. The following points relating to the management of trauma during pregnancy were addressed: quality of evidence assessment, classification of recommendations, main causes of trauma in pregnancy, importance of correct use of seat belts, ultrasound scans and/or pregnancy test in every female of reproductive age, description of physiological changes in pregnancy, classification in primary and secondary survey, primary survey based on ABCD Approach, fetus viable based on the weeks, radiographic studies for maternal evaluation, duration of fetal monitoring, use of anti-D immunoglobulin in rhesus-D-negative pregnant trauma patients, description of dose of RhD-Ig, the way to define gestational age if it was undetermined, descriptions of obstetrical complications, use of tetanus vaccination, and timing to perimortem cesarean section (CS)...

OBJECTIVE: Maternal cardiac arrest is rare. We retrospectively reviewed and reported (1) the incidence of maternal cardiac arrests during admissions for delivery; (2) the characteristics and causes of cardiac arrest; and (3) the mortality rate and outcomes in a referral, single-university, teaching hospital in Thailand. MATERIALS AND METHODS: Data on 23 cardiac arrests during admissions for delivery in the decade January 2006-December 2015 were retrospectively chart-reviewed...

Cardiac arrest in pregnancy is an uncommon encounter, with the incidence being one in every 12,000 hospital admissions for delivery. Here we present, one such patient and our experience in managing the patient. A 23-year-old, third-trimester pregnant female presented with a history of polytrauma following a road traffic accident. On initial assessment, she was in cardiac arrest. We initiated high-quality cardio-pulmonary resuscitation (CPR) as per advanced cardiac life support (ACLS) protocol. We also performed a perimortem cesarean section within four minutes of cardiac arrest...

INTRODUCTION: Maternal cardiac arrest is a rare condition. Cardiopulmonary resuscitation (CPR) in pregnancy is different from that in other populations due to physiological changes in patients. Extracorporeal cardiopulmonary resuscitation (ECPR) is recommended in patients having cardiac arrest with potentially reversible etiologies. However, data regarding ECPR in pregnancy are limited. CASE SUMMARY: A 24-year-old woman with a 33-week twin pregnancy developed witnessed cardiac arrest in an antenatal clinic...

Amniotic fluid embolism is a rare syndrome characterized by sudden cardiorespiratory collapse during labor or soon after delivery. Because of its rarity, many obstetrical providers have no experience in managing amniotic fluid embolism and may therefore benefit from a cognitive aid such as a checklist. We present a sample checklist for the initial management of amniotic fluid embolism based on standard management guidelines. We also suggest steps that each facility can take to implement the checklist effectively...