emergency cesarean delivery
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Resuscitation team leaders should activate the protocol for an emergency cesarean delivery as soon as a cardiac arrest is identified in a pregnant woman with an obviously gravid uterus. When the gravid uterus is large enough to cause maternal hemodynamic changes due to aortocaval compression, emergency cesarean section should be considered, regardless of fetal viability.
Why perform a C-section? Several case reports indicate a return of spontaneous circulation or improvement in maternal hemodynamic status only after the uterus has been emptied (Vanden Hoek et al, 2010). No cases of worsened maternal status after C-section were reported. The critical point to remember is that both the mother and infant may die if the provider cannot restore blood flow to the mother's heart.
The five minute window that providers have to determine if cardiac arrest can be reversed by BLS and ACLS was first initiated in 1986 and has been perpetuated since that time. The rescue team is not required to wait five minutes before initiating emergency surgery, and there are some circumstances which support an earlier start. When the maternal prognosis is grave and resuscitative efforts appear futile, moving straight to an emergency C-section may be appropriate, especially if the fetus is viable.
Why perform a C-section? Several case reports indicate a return of spontaneous circulation or improvement in maternal hemodynamic status only after the uterus has been emptied (Vanden Hoek et al, 2010). No cases of worsened maternal status after C-section were reported. The critical point to remember is that both the mother and infant may die if the provider cannot restore blood flow to the mother's heart.
The five minute window that providers have to determine if cardiac arrest can be reversed by BLS and ACLS was first initiated in 1986 and has been perpetuated since that time. The rescue team is not required to wait five minutes before initiating emergency surgery, and there are some circumstances which support an earlier start. When the maternal prognosis is grave and resuscitative efforts appear futile, moving straight to an emergency C-section may be appropriate, especially if the fetus is viable.