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Challenging the 4- to 5-minute rule: from perimortem cesarean to resuscitative hysterotomy.

Abstract：

:Although perimortem delivery has been recorded in the medical literature for millennia, the procedural intent has evolved to the current fetocentric approach, predicating timing of delivery following maternal cardiopulmonary arrest to optimize neonatal outcome. We suggest a call to action to reinforce the concept that if the uterus is palpable at or above the umbilicus, preparations for delivery should be made simultaneous with initiation of maternal resuscitative efforts; if maternal condition is not rapidly reversible, hysterotomy with delivery should be performed regardless of fetal viability or elapsed time since arrest. Cognizant of the difficulty in determining precise timing of arrest in clinical practice, if fetal status is already compromised further delay while attempting to assess fetal heart rate, locating optimal surgical equipment, or transporting to an operating room will result in unnecessary worsening of both maternal and fetal condition. Even if intrauterine demise has already occurred, maternal resuscitative efforts will typically be markedly improved following delivery with uterine decompression. Consequently we suggest that perimortem cesarean delivery be renamed "resuscitative hysterotomy" to reflect the mutual optimization of resuscitation efforts that would potentially provide earlier and more substantial benefit to both mother and baby.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Rose CH,Faksh A,Traynor KD,Cabrera D,Arendt KW,Brost BC

doi

10.1016/j.ajog.2015.07.019

subject

Has Abstract

pub_date

2015-11-01 00:00:00

pages

653-6, 653.e1

issue

5

eissn

0002-9378

issn

1097-6868

pii

S0002-9378(15)00769-3

journal_volume

213

pub_type

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