Perimortem cesarean delivery: were our assumptions correct?

Maternal cardiac arrest and perimortem caesarean delivery: Evidence or expert-based?

Cardiac arrest during pregnancy.

This chapter discusses the current practice of cesarean delivery, the indications for the operation, the performance of the surgery, and its potential complications. After forceps and vacuum extraction procedures, symphysiotomy is the principal alternative to the cesarean operation. Epidurals do prolong the second stage of labor and increase the use of oxytocin to maintain progress. As the morbidity associated with cesarean delivery remains low, and the risks associated with elective operations are better appreciated, indications for cesarean operations have progressively increased. The chapter reviews the operative technique for cesarean delivery, cesarean hysterectomy, and the surgical management of acute obstetric hemorrhage. Possible immediate post-operative complications of surgical sterilization include infection, bleeding, intraoperative bowel or bladder injury, thromboembolism, and rarely, death. Sterilization failures are often the result of either mistaken identification of some other intraabdominal structure for the fallopian tube, or of incomplete occlusion of the tubal lumina.

Operative Obstetrics: Cesarean Delivery and Surgical Sterilization

Postmortem cesarean sections are rare events, but modern technology is forcing society to explore the definition of viability and the legal rights of both mother and fetus that ultimately will affect the frequency and use of this rare operation. Since the Human Immunodeficiency Virus (HIV) prevalence rate and the number of critically ill obstetrical patients with Acquired Immunodeficiency Syndrome (AIDS) continues to rise, it is reasonable to assume more patients and physicians may be confronted by issues concerning fetal and maternal rights and other considerations in perimortem delivery. A 33-year-old woman, at 27 weeks' gestation, with fulminant AIDS was admitted to the intensive care unit (ICU) in respiratory distress. As her condition deteriorated the complex problem of caring for both mother and fetus emerged. A patient advisory panel explored the issues with the patient, her family, and her health care team. Eventually a peri/postmortem cesarean section was performed on the mother when she suffered an acute fatal cardiorespiratory arrest. With the prevalence of AIDS increasing and with most women not being tested prior to pregnancy, many obstetricians will be confronted with new medical and legal challenges. Establishing comprehensive medical management for the critically ill obstetrical patient and understanding the legal rights of both patients (mother and fetus) will help avoid conflicts and potentially improve survival.

Esposito Ma

Papers

Postmortem cesarean section with infant survival: a case report of an HIV-infected patient.