Postmortem Cesarean Research Articles

Fixing Women: The Birth of Obstetrics and Gynecology in Britain and America by Marcia D. Nichols, and: Baptism through Incision: The Postmortem Cesarean Operation in the Spanish Empire ed. by Martha Few, Zeb Tortorici, and Adam Warren (review)

Fixing Women: The Birth of Obstetrics and Gynecology in Britain and America by Marcia D. Nichols, and: Baptism through Incision: The Postmortem Cesarean Operation in the Spanish Empire ed. by Martha Few, Zeb Tortorici, and Adam Warren (review)

Medicine, Religion, and Women's History - Baptism Through Incision: The Postmortem Cesarean Operation in the Spanish Empire. By Martha Few, Zeb Tortorici, and Adam Warren. University Park: Penn State University Press, 2020. Pp. 152. $15.99. E-book.

Medicine, Religion, and Women's History - Baptism Through Incision: The Postmortem Cesarean Operation in the Spanish Empire. By Martha Few, Zeb Tortorici, and Adam Warren. University Park: Penn State University Press, 2020. Pp. 152. $15.99. E-book. - Volume 78 Issue 3

Baptism through Incision: The Postmortem Cesarean Operation in the Spanish Empire

Baptism through Incision: The Postmortem Cesarean Operation in the Spanish Empire

Reseña histórica: La operación cesárea en el Perú.

La primera cesárea en el Perú, se realiza en 1861 por el Dr. Camilo Segura en el Hospital Maternidad de Lima (cesárea post morten).

Postmortem Cesarean Section: A Case Report

Postmortem cesarean section is a rare event that usually ends up with the mortality of the fetus. A 32-year-old multigravid woman at 34th week of gestation was transferred to the emergency ward due to cardiopulmonary arrest after a traffic accident. A postmortem cesarean section was performed at the 20th minute of the maternal cardio pulmonary arrest and a live fetus was delivered initially. Because of the potential for the survival of a normal infant, obstetricians must consider a cesarean delivery in any pregnant woman that undergone a cardiopulmonary arrest in the third trimester. In this case report. Indications and prognostic factors for fetal well-being in case of a postmortem cesarean section are discussed.

Postmortem cesarean: report of our successful neonatal outcomes after severe trauma during pregnancy and review of the literature

Postmortem cesarean is delivering of a child by cesarean section after the death of the mother. A prompt decision for cesarean delivery is very important in such cases. The survival of both the mother and the baby is dependent on a number of factors, including the time between maternal cardiac arrest and delivery, the underlying reasons for the arrest, the location of the arrest and the skills of the medical staffs. The earlier the fetus is delivered following maternal arrest the better is the fetal survival. Cesarean section should be performed no later than 4 minutes after initial maternal arrest. A fetus delivered within 5 minutes from initiation of CPR (cardiopulmonary resuscitation) has the best chance for survival. We reported 2 cases of successful postmortem cesarean section done 45 and 15 minutes after maternal death. The 1st case was a 29-year-old pregnant woman at 37 weeks gestation with cardiopulmonary arrest following gunshot head injuries. The baby survived with neurological sequels and ongoing treatment at our newborn intensive care unit. Second case admitted to the emergency service was a 28-year-old primigravida of 31 weeks gestation with cardiopulmonary arrest due to massive brain and thoracic hemorrhage after a road traffic accident. The baby recovered without neurological sequels.

Remarks on guidelines ERC 2000: cardiac arrest associated with pregnancy

We would like to make some comments about managing cardiopulmonary arrest in pregnant women as it is described in the guidelines of Resuscitation 2000;46:293–5 [[1]Special issue. International Guidelines 2000 for CPR and ECC—A Consensus on Science. Resuscitation 2000;46:293–5.Google Scholar]. The International 2000 guideline states that it is not advisable to resuscitate a pregnant woman lying on her back because the gravid uterus may obstruct venous return via the inferior vena cava and therefore chest compression is more less likely to be effective. Indeed, studies confirm that applying a partial left lateral tilt to the patient will relieve the aorto-caval compression [[2]Johnson MD, et al. Cardiopulmonary resuscitation. In: Gambling DR, Douglas MJ, editors. Obstetric anaesthesia and uncommon disorders. Philadelphia: WB Saunders; 1998. p. 51–74.Google Scholar]. Rees and Willis [[3]Rees G.A.D Willis B.A Resuscitation in late pregnancy.Anaesthesia. 1988; 43: 347-349Crossref PubMed Scopus (127) Google Scholar] conclude that the best compromise for cardiopulmonary resuscitation (CPR) is achieved by wedging the patient at an angle of 27°. However at this angle there is a disadvantage in that the rescuer can provide only 80% of the transmitted external resuscitative force. Because the transmission forces during external CPR in this position are not perpendicular to the thorax and a part of the transmitted force is lost, left lateral positioning for CPR is not ideal. Overturned chairs and positioning the patient in the full lateral position as shown in Fig. 1, page 294 of the International resuscitation guidelines 2000 [[1]Special issue. International Guidelines 2000 for CPR and ECC—A Consensus on Science. Resuscitation 2000;46:293–5.Google Scholar] make external CPR impossible [[3]Rees G.A.D Willis B.A Resuscitation in late pregnancy.Anaesthesia. 1988; 43: 347-349Crossref PubMed Scopus (127) Google Scholar]. Because chest compression are more effective in the supine position than in the left lateral wedge position, the best compromise for CPR and optimal venous return is in the supine position with manual displacement of the uterus to the left as recommended by Johnson et al. [[2]Johnson MD, et al. Cardiopulmonary resuscitation. In: Gambling DR, Douglas MJ, editors. Obstetric anaesthesia and uncommon disorders. Philadelphia: WB Saunders; 1998. p. 51–74.Google Scholar]. The guidelines indicate no changes to the standard algorithms for medication, intubation and defibrillation. However intubation is more difficult and defibrillation is different compared to the non-pregnant cardiac-arrest situation. As pregnant women present dextroversion of the heart, one paddle should be placed below the right clavicle in the midclavicular line while the second paddle should be placed outside the normal cardiac apex avoiding breast tissue [[4]Luppi C.J Cardiopulmonary resuscitation: pregnant women are different.AACN Clin Issues. 1997; 8: 574-585Crossref PubMed Scopus (18) Google Scholar]. Also, the timing of emergency caesarean section is open to criticism. Understandably, the discussion is not easy. In the International Guidelines 2000 on pages 294 and 295 [[1]Special issue. International Guidelines 2000 for CPR and ECC—A Consensus on Science. Resuscitation 2000;46:293–5.Google Scholar] it is recommended to attempt basic life support (BLS) first and only to proceed with emergency caesarean section if advanced measures have been commenced already and the problems are not immediately reversible. But hesitation punishes the pregnant patient and guidelines do not give clear guidance when emergency caesarean section should be started during the algorithm. The guideline on page 294 suggests that after BLS and advanced life support (ALS) have failed, and if there is some chance that the fetus is viable, immediate perimortem caesarean section has to be considered. This can be confusing for medical personnel unfamiliar with the difficulties of parturient cardiac arrest. Even if the fetus is not viable emergency cesarean section is required in order to improve venous return and consequently the cardiac output during CPR. Following delivery of the fetus cardiac output in non cardiac arrest patients can increase up to 80% above predelivery values [[5]Ueland K Hansen J.M Maternal cardiovascular dynamics 3. Labor and delivery under local and caudal analgesia.Am. J. Obstet. Gynecol. 1969; 103: 8-18Abstract Full Text PDF PubMed Scopus (138) Google Scholar]. Because maternal brain damage is likely after 4 min of sustained cardiac arrest [6American Heart Association. Textbook of advanced cardiac life support. Dallas: AHA; 1987.Google Scholar, 7Archer G.W Marx G.F Arterial oxygen tension during apnoea in parturient women.Br. J. Anaesth. 1974; 46: 358-360Crossref PubMed Scopus (122) Google Scholar] and may be irreversible after 6 min [[8]Weber C.E Postmortem cesarean section: review of the literature and case reports.Am. J. Obstet. Gynecol. 1971; 110: 158-165PubMed Scopus (49) Google Scholar] perimortem cesarean section should be considered at the fourth minute of cardiac arrest. It should be mentioned that, after perimortem delivery, 10 units of oxytocin should be injected in the myometrium to prevent uterine bleeding. Also, if external chest compressions are unsuccessful after 15 min open cardiac message should be considered (Johnson et al. 1998).

Postmortem Cesarean Section Following Maternal Burn

Objective: Postmortem cesarean section of a living infant is very rare. There are few cases of surviving infants delivered more than 15 min after maternal cardiopulmonary arrest. Timing of the operation is critical for the infant. Case Report(s): We report on a case of a living male infant delivered by a 37-year-old primigravida woman, at approximately 39-weeks’ gestation, who died after having been severely burned in an accident. A postmortem cesarean section was performed 55 min after the accident and probably more than 28 min after maternal cardiopulmonary arrest. The baby was kept alive with ventilatory assistances but eventually died 5 months later. Conclusion(s): To the best of our knowledge, the present case might show the longest interval between maternal death and infant birth of more than 28 min. Although this fetus had a poor outcome, obstetricians should consider a cesarean section in any pregnant woman during the third trimester with acute cardiopulmonary arrest because of the potential to rescue a normal infant.

Surgery at the Service of Theology: Postmortem Cesarean Sections in Puerto Rico and the Royal Cedula of 1804

O N April 13, 1804, Charles IV issued a royal cedula (admonition with the force of law) ordering the civil and religious officials in Spanish America and the Philippines to ensure that no pregnant woman was buried unless a postmortem cesarean section was carried out. The order was meant to assure that living fetuses received baptism (which the Roman Catholic church considered an indispensable requirement for salvation) and to save them from being buried inside their mothers.' At the time, European monarchs generally were concerned with expanding the population. But this was also a period in which professional roles had a different definition than we now assign to them. If a surgeon were not quickly available, the operation was to be performed by anyone, following the instructions in the cedula (written by professors of the College of Surgery in Madrid). The overlap in medical and religious expertise was such that midwives and physicians could be trusted to give the correct instructions for baptism, and monks could be renowned for their ideas about physiology. The text provides significant insights into the tensions between the administrative, scientific, and religious spheres of the ancien regime Spanish dominions. It allows us to examine the route through which a request by a priest from Bogota' became law for the entire

Surgery at the Service of Theology: Postmortem Cesarean Sections in Puerto Rico and the Royal Cedula of 1804

Surgery at the Service of Theology: Postmortem Cesarean Sections in Puerto Rico and the Royal Cedula of 1804

Cesarean delivery: A reconsideration of terminology

The terminology we employ influences our perceptions. Thus, we believe in reviewing terminology regularly. The term "cesarean section" should be abandoned. A medical procedure is rarely named after a historic figure, and almost never after an ancient Roman law. Cesarean section has recently been amended to cesarean birth; however, the term is still inadequate. The word "hysterotomy" more appropriately describes the procedure we regularly perform. The adjectives used to describe cesarean birth should also be reevaluated. If we are to keep the term "classical" for the original fundal vertical uterine incision, then the other designations of hysterotomy should retain the same architectural context. Contemporary hysterotomy should be used in reference to a low transverse cesarean. Neoclassical hysterotomy might be used to describe the low vertical procedure. Transitional hysterotomy may be an appropriate term for the "hockey stick" or "J" incision. Cesarean delivery best describes a postmortem cesarean. Vaginal birth after cesarean (VBAC) is inappropriate because a vaginal birth after a cesarean section would not occur if cesarean section refers to a perimortem procedure. Vaginal birth after hysterotomy should be substituted for VBAC. Such revision of our terminology will keep obstetrics at the forefront of medical science and bring us most efficiently into the 21st century.

Infant survival following delayed postmortem cesarean delivery

A 19-year-old multipara was delivered of a living infant by postmortem cesarean 22 minutes after documented maternal cardiac arrest and 47 minutes from the fatal injury. Neonatal follow-up at 18 months of age demonstrated no evidence of neurologic damage.

INFANT SURVIVAL FOLLOWING DELAYED POSTMORTEM CESAREAN DELIVERY

A 19-year-old multipara was delivered of a living infant by postmortem cesarean 22 minutes after documented maternal cardiac arrest and 47 minutes from the fatal injury. Neonatal follow-up at 18 months of age demonstrated no evidence of neurologic damage.

Perimortem Cesarean Delivery

Postmortem cesarean delivery is an operation that has been practiced since antiquity. In previous centuries low infant survival rates led to negative opinions regarding the operation's usefulness. A review of the past centuries' cases and a review of fetal physiology suggest that to obtain optimum infant survival, cesarean delivery should be initiated within four minutes of maternal cardiac arrest. The physiology of cardiopulmonary resuscitation during pregnancy is analyzed, and recent cases of maternal cardiac arrest with successful maternal resuscitation are reviewed. This data suggests that perimortem cesarean delivery initiated within four minutes of maternal cardiac arrest will yield the highest rates of maternal survival. Legal liability from the operation is minimal.

Postmortem Cesarean Section with Recovery of Both Mother and Offspring

Postmortem Cesarean Section with Recovery of Both Mother and Offspring

Postmortem cesarean section

Postmortem cesarean section continues to carry a bleak fetal outlook. The present report adds to the literature three recent cases in which the infant was not saved. Analysis of the literature is used to produce guideposts to timing and performance of the procedure. The possible impact of today's technology on the problem is discussed. The need for earlier intervention in the patient near death is presented as a possible method of improving fetal salvage.

Successful Postmortem Cesarean Section

Successful Postmortem Cesarean Section

A case of dissecting aneurysm of the aorta causing maternal death at seven months with postmortem cesarean delivery of a live premature infant

Dissecting aneurysm of the aorta has been described by Schnitker and associates as a rare complication of pregnancy. In their review of the literature through 1944, a total of 49 females with the disease under the age of 40 were reported. In 24 of these patients the lesion was associated with pregnancy. They suggested the possibility of a disturbance in lipoid metabolism during pregnancy which may cause an alteration in the media of the blood vessels and predispose to a dissecting aneurysm.Of their 24 cases, 2 occurred post partum and two with the onset of labor. The other 20 cases all occurred at varying times during pregnancy, thus eliminating to a large extent the factor of the trauma of labor as a causative element. The average gestation of the undelivered patients was 36 to 40 weeks. In 6 instances a hurried cesarean section was performed and 3 viable infants were delivered. (The article does not state whether the sections were performed before or after the maternal death except in one case where the mother survived for three years.)The present case is reported because of the rarity of the condition in pregnancy and because a postmortem cesarean section was performed and a live infant obtained.

Successful post-mortem cesarean section following death from pulmonary tuberculosis.

SUCCESSFUL post-mortem cesarean sections performed on patients who have died from various causes have not been frequently reported in the past. In all the medical literature there are fewer than 100 cases recorded. Rescuing a living baby from a patient who has died of pulmonary tuberculosis is relatively uncommon, one of the earliest successful cases having been described by Huguier1 in 1829. The following case is presented because of the scarcity of such reports and because it is believed to be the first in this country. Case Report B. W., an 18-year-old Negress, was admitted to the Rutland State Sanatorium . . .

Successful Post-Mortem Cesarean Section

Successful Post-Mortem Cesarean Section