What is Perimortem Cesarean?
The name “perimortem cesarean section” refers to the surgical process of delivering a baby when the mother is near death. As you can imagine, making the decision to perform this surgery is stressful and anxiety-inducing due to the emergency circumstances and extremely high stakes involved. What’s more, this is one of the oldest types of surgical procedures in existence.
Unfortunately, there aren’t any clear rules or guidelines about when this operation should be done. The lack of agreed-upon guidance can make the situation even more nerve-wracking. That’s why it’s absolutely crucial for emergency medical professionals know when it might be necessary to perform a perimortem cesarean section, as well as how to carry out the operation swiftly and effectively. This knowledge can significantly increase the survival chances for both the mother and the baby.
What Causes Perimortem Cesarean?
The exact origin of the term “C-section” and when it was first done is not certain, and there’s a common mistaken belief that Julius Caesar was born through this procedure. However, historical records indicate that at the time of Caesar’s birth, this operation was typically only done if the mother had already passed away in an attempt to maintain the population. In fact, Caesar’s mother, Aurelia, was alive during his challenging exploits, such as his invasion of Britain in 55 BC.
As for where the name “C-section” comes from, there are a few theories. One suggests that a law called Lex Regia, or Royal Law, required that if a pregnant woman passed away, her baby couldn’t be buried with her and had to be delivered and buried separately. This law later became known as Lex Caesarea, or Caesarian Law, under Julius Caesar’s rule. Another theory is that the name comes from the Latin verb “caedare,” which means ‘to cut’.
The exact time when this procedure was first done is also not clear. According to Greek mythology, the God Apollo performed the first C-section to deliver Asclepius. In terms of modern history, some sources suggest that the first recorded C-section happened in Switzerland in 1500, while others say it was done by a midwife in the British Isles in 1738. In both cases, the mother survived the operation.
Risk Factors and Frequency for Perimortem Cesarean
Cardiac arrest during pregnancy is quite rare, occurring in approximately one out of 30,000 pregnancies. Due to the uncommon occurrence of cardiac arrest in pregnant women, a procedure known as perimortem cesarean section is rarely performed. The main cause of cardiac arrest during pregnancy is often related to anesthesia provided during childbirth, while high incidence due to trauma is very unusual.
Signs and Symptoms of Perimortem Cesarean
In emergency situations involving a pregnant woman, usually there isn’t much time to gather detailed medical history. However, if possible, emergency medical personnel should try to find out certain key information. This includes any known allergies, current medications, past medical problems, recent meals, details about the accident, and prenatal care received.
- Firstly, they need to know how many babies she is carrying in order to be prepared for the possibility of multiple resuscitations.
- Secondly, it’s important to find out the baby’s due date, the date of the woman’s last menstrual cycle, or estimated pregnancy stage. This helps to gauge the baby’s age and viability, which is crucial if an emergency cesarean section may be needed.
- Lastly, knowing whether any drugs are present in the woman’s system can inform the treatment of the baby, particularly if specific antidotes are required.
Testing for Perimortem Cesarean
If a pregnant patient loses circulation, the doctor must quickly check her vital signs to understand how severe the situation is. This evaluation should be done as quickly as possible so that the doctors can decide on the appropriate course of action, including monitoring the baby through what’s known as fetal tocometry, a way of checking the baby’s heart rate and possible contractions. Doctors who specialize in pregnancy and childbirth, known as obstetricians, should be informed and ready to assist as soon as possible.
The process to regain circulation should be started within 4 minutes from when the pulse was lost for the best chance of a positive outcome.
There might be instances where it is not known how far along the pregnancy is. If this is the case, the doctor can measure the height of the uterus (also known as the uterine fundal height) from the belly button level. If this measurement is around the belly button level, it can suggest that the pregnancy is around 24 weeks along.
Treatment Options for Perimortem Cesarean
In 2005, the American College of Obstetrics and Gynecology (basically a group of experts in pregnancy and childbirth) said that there wasn’t enough information to guide doctors on exactly when to perform a particular procedure related to emergency childbirth during cardiac arrest. However, most agree that it should be thought about when a pregnant woman has a cardiac arrest and the pregnancy is more than 23 weeks along. Unfortunately, there isn’t much information about the best time to deliver the baby after a cardiac arrest. But, in a hospital setting, chances of survival significantly decrease when delivery occurs more than 5 minutes after the mother’s heart stops. This has led to a 4-minute rule becoming a standard practice: If a pregnant woman’s heart stops, she will receive CPR for 4 minutes, and the aim will be to deliver the baby by the fifth minute. This was recently challenged by a researcher named Benson and his colleagues.
The procedure can be quite straightforward but tends to cause anxiety and fear among doctors and medical staff because of the serious circumstances under which it is performed. It’s carried out rapidly and can be done by a range of healthcare professionals, including obstetricians, paramedics, trauma surgeons, or emergency medicine doctors. It’s important not to postpone checking the baby’s heartbeat. While the mother is being resuscitated and the procedure is being carried out, the newborn intensive care unit and other medical staff should prepare to resuscitate the baby.
Here are the steps for the procedure:
1. The pregnant patient is placed on her side, and if there’s time, a Foley (a type of catheter or tube) is placed to drain her bladder.
2. The surgeon makes a cut from the lower part of the breastbone to the pubic bone, going through all layers of the abdominal wall.
3. The bladder is emptied using the Foley catheter and moved out of the way manually.
4. Another cut is made in the uterus from top to bottom, with the aim not to cut too deeply and injure the baby.
5. The baby is gently removed from the uterus.
6. Like normal deliveries, the baby’s mouth, then nose, are suctioned to remove any fluids. The umbilical cord is then clamped and cut.
Emergency life-saving treatment continues on the mother, while the baby is also started on the necessary emergency treatments. Be aware that there is likely to be a large amount of blood collected in the abdominal and pelvic cavities. Together with the enlarged uterus, this makes it challenging to carry out resuscitation efforts.
What else can Perimortem Cesarean be?
Here are some health conditions that could occur:
- Infection in the lining of the uterus (Endometritis abscess)
- Unusual childbirth presentations, such as the baby’s face or forehead coming out first (Face and brow presentation)
- Problems with the stomach and intestines which could lead to blockages (Gastrointestinal dysfunction and obstruction)
- Blood clot that forms in the pelvic area (Pelvic hematoma)
- Inflammation and clotting in veins located in the pelvis (Pelvic vein thrombophlebitis)
- Problems related to healing of a surgical wound (Wound complications)
