Perimortem caesarean birth

You are three minutes into a cardiac arrest on labour ward. Compressions are good, the airway is secured, adrenaline is in, and there is still no output. Someone asks whether they should call theatre. The correct answer is no — and the fact that you know why, and that you have already asked for the scalpel, is the whole of this topic.^[10][4]

Overview — what the operation is for

The name is misleading and the misunderstanding costs lives. Perimortem caesarean birth is a maternal resuscitation manoeuvre. Any baby who survives is a very welcome bonus, not the indication.^[4][11]

That is why the literature has been moving to resuscitative hysterotomy — a name that puts the purpose in the title and stops teams treating the procedure as an obstetric decision to be deferred to an obstetrician who is nine minutes away.^[4][7]

Three distinctions the examiner will want: ^[4][11]

• Perimortem caesarean birth — performed during arrest, as part of resuscitation.
• Emergency caesarean for fetal compromise — the mother has a circulation; the indication is fetal.
• Postmortem caesarean — after death is confirmed, for fetal or medico-legal reasons alone.^[4]

References19ShowHide

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2. [2]Katz V, Balderston K, DeFreest M Perimortem cesarean delivery: were our assumptions correct? Am J Obstet Gynecol, 2005.PMID 15970850
3. [3]Einav S, Kaufman N, Sela HY Maternal cardiac arrest and perimortem caesarean delivery: evidence or expert-based? Resuscitation, 2012.PMID 22613275
4. [4]Rose CH, Faksh A, Traynor KD, Cabrera D, Arendt KW, Brost BC Challenging the 4- to 5-minute rule: from perimortem cesarean to resuscitative hysterotomy Am J Obstet Gynecol, 2015.PMID 26212180
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17. [17]Enomoto N, Yamashita T, Furuta M, Tanaka H, Ng ESW, Matsunaga S, Sakurai A Effect of maternal positioning during cardiopulmonary resuscitation: a systematic review and meta-analyses BMC Pregnancy Childbirth, 2022.PMID 35216559
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