Perimortem caesarean section: A review of the anaesthetist's nightmare

Abstract

A perimortem caesarean section is a rare event, but is gaining more support as an essential part of maternal and foetal resuscitation during maternal cardiac arrest in late pregnancy. The anatomical and physiological changes occurring in pregnancy make resuscitation difficult and require key interventions to improve the outcome for both the mother and child. Specific obstetric resuscitation guidelines are required to raise awareness and for further training. Early recourse to perimortem caesarean section when resuscitation is failing may increase survival and requires a multidisciplinary team trained in maternal and neonatal resuscitation to make appropriate rapid decisions. Key interventions including left uterine displacement, early advanced airway control and perimortem caesarean section should be integral to maternal resuscitation for a good outcome. Simulation training based on specific obstetric resuscitation guidelines should be tailored and adopted by individual centres to facilitate rapid decisions for effective resuscitation, including the performance of a perimortem caesarean section.