Perimortem Cesarean Section

One of the most difficult decisions an emergency physician will ever have to make in their career is the decision to perform a perimortem cesarean section in a case of maternal cardiac arrest. Because this is fortunately a rare event, there is very little literature about this procedure. However, a recent retrospective review of 38 published cases of perimortem cesarean section noted 28 successful deliveries. Of these, only 8 mothers suffered traumatic arrest.³¹ Most cases documented improved maternal hemodynamics with the performance of the cesarean section. The authors acknowledge that there is a large selection bias in this study, with successful resuscitations far more likely to be published.31 Delivery of the fetus allows for more effective cardiopulmonary resuscitation (CPR) and diverts all circulating blood volume to the mother. If possible, it is recommended to begin the procedure within 4 minutes of maternal cardiac arrest, although cases of both maternal and fetal survival have been reported with times greater than 15 minutes.³¹ Figure 7 illustrates the technique of a perimortem cesarean section.

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