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Perimortem Caesarian Section
Questions and Answers
1
What is a perimortem caesarian section (PMCS)?
PMCS is the delivery of a baby by means of a surgical incision into the uterus, in the event the mother is in cardiac arrest. The steps to perform a perimortem C-section are essentially the same as those done in a normal caesarian section. The main difference between PMCS and a normal caesarean section is simply the acuity, shifting the balance of risks and benefits in favor of allowing nonobstetricians to do the procedure in an attempt to save the mother and/or baby in extremis.
2
When was this first described?
The Roman general Scipio Africanus was reported to have been delivered by perimortem C-section in 237 BC. There are reports of PMCS being performed in the late 19th and early 20th centuries for salvage of the fetus. It was during this time period that PMCS began to be viewed as a legitimate medical procedure.
3
Is a resuscitative hysterotomy different from PMCS?
This is an alternate nomenclature for the same procedure. The term has been advocated to emphasize the fact that delivery has physiologic benefits for the mother, as well as the fetus.
4
Why is this procedure done?
Delivery will reduce demand on maternal circulation, relieve aortocaval compression, and improve fetal oxygenation. Theoretically, this should improve the chances for both maternal and fetal survival. As much as 40% of the maternal cardiac output can go to the fetus, so delivery can reduce this load on the circulatory system. Aortocaval compression significantly reduces cardiac output in the supine pregnant woman and greatly reduces the efficacy of chest compressions to a large extent. Closed-chest cardiopulmonary resuscitation (CPR) delivers only 20%–30% of normal cardiac output, even under optimal conditions. This in turn will not be adequate to support fetal circulation, so delivery may improve fetal survival as well.
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