Alexander Ajit M., Lobrano Susan
LSU Health Sciences
LSU Health Science Center
Perimortem cesarean delivery (PMCD), also referred to as resuscitative hysterotomy by some clinicians, is an emergency procedure performed when a pregnant patient experiences cardiac arrest, usually conducted during resuscitation efforts, to relieve maternal aortocaval compression and facilitate both maternal and fetal survival. Maternal cardiac arrest is a rare catastrophic condition that can result secondary to trauma, acute hemorrhage, heart failure, amniotic fluid embolism, drug use, sepsis, thromboembolism, severe hypertensive disorders, or anesthesia complications. The incidence of maternal cardiac arrest is estimated to be 1 in 30,000 pregnancies and 1 in 12,000 delivery admissions. Due to the rarity of this event, the evidence guiding PMCD recommendations, including optimal techniques and indications, is also limited. While outcomes for both mother and baby vary, timely PMCD at 20 weeks or more of gestation can improve survival when resuscitation efforts fail. However, the decision to perform PMCD is challenging and influenced by several factors, including the cause of arrest, gestational age, and available resources. The most widely accepted guidelines regarding PMCD are those established by the American Heart Association (AHA), which recently updated recommendations on cardiopulmonary resuscitation in pregnant patients and PMCD. The primary purposes of PMCD are to improve the effectiveness of maternal resuscitation by enhancing venous return and to deliver the fetus promptly, minimizing the risk of brain damage from oxygen deprivation. Research indicates timely PMCD improves outcomes, with a recommended delivery time within 5 minutes of cardiac arrest. Experts recommend the procedure be initiated as soon as possible after the decision to proceed with PMCD is made at the site of resuscitation rather than moving the patient or awaiting surgical equipment to improve maternal and fetal survival. Ideally, however, institutions that provide obstetrical care should have healthcare teams assigned and protocols already instituted and prepared to treat maternal cardiac arrest and perform PMCD if needed.
濒死剖宫产（PMCD），一些临床医生也称之为复苏性子宫切开术，是在怀孕患者发生心脏骤停时进行的紧急手术，通常在复苏过程中实施，以缓解母体主动脉腔静脉受压，促进母体和胎儿存活。母体心脏骤停是一种罕见的灾难性状况，可能继发于创伤、急性出血、心力衰竭、羊水栓塞、药物使用、败血症、血栓栓塞、严重高血压疾病或麻醉并发症。据估计，母体心脏骤停的发生率在每30000次妊娠中有1例，在每12000例分娩入院中有1例。由于这一事件的罕见性，指导PMCD建议（包括最佳技术和适应症）的证据也很有限。虽然母婴的结局各不相同，但在妊娠20周或更晚时及时进行PMCD可在复苏努力失败时提高存活率。然而，决定是否进行PMCD具有挑战性，并且受到多种因素影响，包括心脏骤停的原因、孕周和可用资源。关于PMCD最广泛接受的指南是美国心脏协会（AHA）制定的指南，该协会最近更新了关于孕妇心肺复苏和PMCD的建议。PMCD的主要目的是通过增强静脉回流来提高母体复苏的有效性，并迅速娩出胎儿，将缺氧导致脑损伤的风险降至最低。研究表明，及时进行PMCD可改善结局，建议在心脏骤停后5分钟内分娩。专家建议，一旦在复苏现场做出进行PMCD的决定，应尽快启动该手术，而不是转移患者或等待手术设备，以提高母婴存活率。然而，理想情况下，提供产科护理的机构应已分配医疗团队并制定协议，随时准备治疗母体心脏骤停并在需要时进行PMCD。
