Peri-Mortem Cesarean Section from EmCrit–An Important Subject for Students of Advanced Life Support In Obstetrics

The purpose of the peri-mortem cesarean section is to save the mother’s life.

That is why the procedure, which is incredibly unlikely to occur in any given non-obstetric physician’s career, is worth mastering.

Last year  (2014), I took the Advanced Life Support in Obstetrics course. It was  excellent and I will definitely take it again. Here is a link to the list of my posts on the ALSO course.

And Dr. Weingart of EMCrit has posted on perimortem C-section at EMCrit Conference Blast Winner: Peri-Mortem C-Section. February 12, 2013 by emcrit. The link to the post is in the show notes. And as always with EMCrit posts, be sure and review all of the readers thoughtful comments.

Dr. Weingart includes the following update in the post which again is why the topic very relevant to primary care physicians:

“In one case series, 12 of 20 women had return of spontaneous circulation immediately after delivery (EMCNA, Vol. 30, pg. 949). HT to emedhome.” [Emphasis added]. Unfortunately, Emergency Clinics of North America is not open access, so we can’t review the article. However, PubMed has a list of recent articles on this subject (accessed 5/20/2015), and some of these are open access. See Additional Resources at the end of the post for some of those articles.

Link to Simulated Crash C-Section from Jason Wagner 3 years ago from Vimeo. And the video has outstanding section on how to make an inexpensive simulator to practice the procedure.

A big potential problem after a successful perimortem c-section is continued bleeding from uterine atony. Please see Additional Resources for some articles addressing this important problem

And Dr. Weingart states that the video embedded below is “the best video on the procedure I have seen on life-identical model”:

Emergency Vertical C-Section for Fetal Distress

And here is the EMCrit Wee Video:

Additional Resources:

Perimortem C-section at St.Emlyn’s post from St. Emlyn’s
February 4, 2013

Perimortem caesarean section. [PubMed Abstract]                                                               Emerg Med J. 2015 Feb 24. pii: emermed-2014-204466. doi: 10.1136/emermed-2014-204466. [Epub ahead of print]

Out-of-Hospital Perimortem Cesarean Section as Resuscitative Hysterotomy in Maternal Posttraumatic Cardiac Arrest.   [PubMed Abstract] [Full Text HTML] [Full Text PDF]                                                                                                                                 Case Rep Emerg Med. 2014;2014:121562. doi: 10.1155/2014/121562. Epub 2014 Oct 3

Perimortem cesarean section for maternal and fetal salvage: concise review and protocol. [PubMed Abstract] [Full Text PDF]                                                                       Acta Obstet Gynecol Scand. 2014 Oct;93(10):965-72. doi: 10.1111/aogs.12464. Epub 2014 Aug 27

Perimortem cesarean section: three possible procedures to overcome atonic bleeding after successful resuscitation. [Full Text PDF]                                                     Acta Obstet Gynecol Scand. 2015 Jan;94(1):121. doi: 10.1111/aogs.12501. Epub 2014 Sep 30.

Uterine compression sutures for postpartum hemorrhage: an overview.              [PubMed Abstract] [Full Text HTML] [Full Text PDF]                                                            Acta Obstet Gynecol Scand. 2013 Apr;92(4):378-85. doi: 10.1111/aogs.12077. Epub 2013 Feb 9.

PubMed list of recent articles on perimortem Cesarean section (accessed 5/20/2015).

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