Care of the Critically Ill Pregnant Patient and Perimortem Cesarean Delivery in the Emergency Department

• Published in: The Journal of emergency medicine Vol. 51; no. 2; pp. 172 - 177
• Main Authors: Healy, Megan E., MD, Kozubal, Dana E., MD, Horn, Amanda E., MD, Vilke, Gary M., MD, Chan, Theodore C., MD, Ufberg, Jacob W., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2016
• Subjects: Advanced Cardiac Life Support - methods; Cesarean Section - methods; Critical Illness; Emergency; emergency department; Emergency Service, Hospital; Female; Heart Arrest - therapy; Humans; maternal resuscitation; perimortem cesarean delivery; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Cardiovascular - therapy; emergency department; perimortem cesarean delivery; maternal resuscitation
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2016.04.029

Abstract Background Maternal resuscitation in the emergency department requires planning and special consideration of the physiologic changes of pregnancy. Perimortem cesarean delivery (PMCD) is a rare but potentially life-saving procedure for both mother and fetus. Emergency physicians should be aware of the procedure's indications and steps because it needs to be performed rapidly for the best possible outcomes. Objective We sought to review the approach to the critically ill pregnant patient in light of new expert guidelines, including indications for PMCD and procedural techniques. Discussion The prevalence of maternal cardiac arrest and survival outcomes of PMCD in the emergency department setting are difficult to estimate. Advanced cardiovascular life support protocols should be followed in maternal arrest with special considerations made based on the physiologic changes of pregnancy. The latest recommendations for maternal resuscitation are reviewed, including advance planning, rapid determination of gestational age, emergent delivery, and postprocedure considerations for PMCD. Conclusions Maternal resuscitation requires knowledge of physiologic changes and evidence-based recommendations. PMCD outcomes are best for both mother and fetus when the procedure is performed rapidly and efficiently in the appropriate setting. Emergency physicians should be familiar with this unique clinical scenario so they are adequately prepared to intervene in order to improve maternal and fetal morbidity and mortality.