Perimortem Caesareans Section -Every Minute C...

Perimortem Caesareans Section -Every Minute Counts!

Author Name : Dr Mohini Abreo, Dr Lamya Al Kharusi

We report a case of perimortem caesarean section performed on a collapsed mother with an 8 months viable pregnancy. A young multigravida with an uncomplicated pregnancy was brought in a collapsed state in the accident and emergency of Sultan Qaboos Hospital, Oman. Immediate cardiopulmonary resuscitation was commencedbut in view of failure of revival of mother in 4 minutes a perimortem caesarean section was performed in a desperate attempt to save the mother. Cardiopulmonary resuscitation was continued for 50 minutes after which the mother was declared dead. The new-born suffered from Grade III HIE, neonatal septicaemia and developmental delay.

Such cases are rarely encountered and puts the physician in a major dilemma. I think this case is important as an awareness of how to manage these cases to save two lives. The American Heart Association has recommended Perimortem caesarean section when the mother cannot be revived within 4 minutes of resuscitation. Delivery of the fetus leads to relieving of the aortocaval compression and increase in the cardiac output by 25%. Though the best survival outcomes are when the perimortem caesarean is performed within five minutes, one should still pursue the caesarean section if more time has elapsed. The wedge or the lateral tilt can be removed and more effective compressions could be performed in a supine position.