Perimortem Caesarean section ( PMCS) ;Validating the technique

1. OPTIONALLOGO HERE Perimortem Caesarean section ( PMCS) ;Validating the technique Ellepola Hasthika1, Seneviratna S2, Haran Mano12 1 Department of Obstetrics and Gynaecology Logan Hospital, QLD, Australia 2 Schools of Medicine, Griffith University, QLD, Australia OPTIONALLOGO HERE Clinical cases Results Introduction Conclusions • Case 1 • A 36 year old uncomplicated mulipara was in active labour • Subsequently; experienced a cardiopulmonary arrest secondary to amniotic fluid embolism (AFE). • Code blue was called and cardiopulmonary resuscitation (CPR) commenced • To facilitate on going CPR perimotem caesarean section was performed in the birthing suit an aid of a scalpel blade • Case 2 • A 24 years old uncomplicated primi in labour was fully dilated and had a cardiac arrest in the birthing suite • CPR was commenced and with in four minutes of unsuccessful resuscitation a PMCS was performed • Due to the clinical urgency fetus was delivered with an aid of a scalpel blade • Findings • In both occasions to facilitate the ongoing resuscitation Obstetrics team performed a PMCS approximately between 4-5 minutes since commencement of CPR • Scalpel blade with out the handle was the only surgical instrument that was used. • Skin to delivery time was between 15 to 30 seconds • Findings • In both occasions to facilitate the ongoing resuscitation Obstetrics team performed a PMCS approximately between 4-5 minutes since commencement of CPR • Scalpel blade with out the handle was the only surgical instrument that was used. • Skin to delivery time was between 15 to 30 seconds • Technique • Transverse skin incision performed with the scalpel blade with out the handle and blunt dissection of the subcutaneous tissue • The fascial incision extended bluntly by inserting the fingers of each hand under the fascia and then pulling in a cephalad-caudad direction • Rectus muscle layer and the peritoneum separated bluntly by the operator’s fingers • Lower transverse incision made on the uterus with out reflecting the bladder • Once the fetus delivered in both occasions atonic uterus noted • uterine closure performed in two-layer, continuous closure with absorbable suture • Skin approximated with interrupted stitches using delayed absorbable synthetic sutures • Time lines of the intervention is of extreme importance for both maternal and fetal outcome • Time-consuming activities such as fetal monitoring and transportation to the operating theatre reduce the chances of maternal and neonatal survival and should be avoided • Conclusion • PMCC which is potentially a lifesaving procedure for both mother and baby • Could be promptly performed effectively even in a suboptimum location with minimum surgical instruments • Cardiopulmonary arrest during pregnancy presents a unique clinical scenario involving two patients; the mother and the fetus • Management of these patients demands a rapid multidisciplinary approach • Basic and advanced cardiac life support algorithms should be implemented • The physiological and anatomical changes of pregnancy may require a perimotem caesarean (PMCS) delivery • PMCC is a rare event; only few Obstetricians would have experience in performing this life saving operation. • OBJECTIVES • Validate the technique of this rare Obstetrics procedure based on case series • We describe two cases of cardiac arrest in pregnancy in which a PMCS was performed as part of the resuscitation process • The authors of this study has personally been involved in one or both of the case series References 1 Zelop, CM, Grimes EP. Cardiopulmonary Resuscitation in Pregnancy. In: The textbook of Emergency Cardiovascular Care and CPR Philadelphia 2009. p.538 2Lewis, G. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: Reviewing Maternal Deaths to make Motherhood Safer 2003-2005. The Seventh Confidential Enquiry into Maternal Deaths in the United Kingdom. RCOG Press. 2007