Notes from a Lecture on Perimortem Cesarean
On Tuesday, I attended the larger workplace’s Tuesday morning emergency medicine conference for the first time, as the librarian currently serving them is leaving us for another library and I will be working with emed after she leaves. One of the presentations was on perimortem cesarean (another was on other ob emergencies), which I found quite fascinating.
The presenter indicated that there is limited data on maternal and fetal benefits, with most of the literature in case reports biased toward the positive outcomes. There was also discussion of decision-making, various cases and whether a cesarean would be appropriate, maternal and neonatal resuscitation, triage, and other issues.
Here are a couple of references that came up in the talk for others who might be interested.
- Katz VL, Dotters DJ, Droegemueller W. Perimortem cesarean delivery. Obstet Gynecol. 1986 Oct;68(4):571-6. Review. PMID: 3528956
- Katz V, Balderston K, DeFreest M. Perimortem cesarean delivery: were our assumptions correct? Am J Obstet Gynecol. 2005 Jun;192(6):1916-20; discussion 1920-1. Review. PMID: 15970850
- Morris JA Jr, Rosenbower TJ, Jurkovich GJ, Hoyt DB, Harviel JD, Knudson MM, Miller RS, Burch JM, Meredith JW, Ross SE, Jenkins JM, Bass JG. Infant survival after cesarean section for trauma. Ann Surg. 1996 May;223(5):481-8; discussion 488-91. PMID: 8651739
- Molina-Sosa A, Galvan-Espinosa H, Gabriel-Guzman J, Valle RF. Self-inflicted cesarean section with maternal and fetal survival. Int J Gynaecol Obstet. 2004 Mar;84(3):287-90. PMID: 15001385
- Not mentioned in the talk, but eMedicine also has an overview.
Provides historical perspective, causes of maternal mortality, discussion of the rationale for perimortem cesarean, timing, and medicolegal concerns.
An updated review covering thirty-eight cases from 1985 until 2004 concluding that “Published reports from 20 years support, but fall far from proving, that perimortem cesarean delivery within 4 minutes of maternal cardiac arrest improves maternal and neonatal outcomes.” [I know, when you’re talking perimortem cesarean, you have to wonder how you’re going to improve the maternal outcomes, but apparently sometimes you do get the woman back once the baby has been removed.]
Focused on emergency cesarean in pregnant trauma patients; freely available in PubMed Central.
Yes, “self-inflicted.” As in, this woman performed a cesarean on herself; she and her child both survived. [The Unnecesarean has a few additional links on the story at the bottom of this post.]
The ob emergencies talk that followed this one was excellent and covered topics including miscarriage, ectopic pregnancy, preeclampsia, and others, but I didn’t get any good references for that one – it was presented in a more case discussion-type format.
[Image from the National Library of Medicine’s Images from the History of Medicine collection, Cesarian Section – birth of Aesculapius – Benedetti, A. De re medica, Venice, 1533. This image was used in the presentation.]