Perimortem caesarean section; successful neonatal outcome after preterm delivery: a case report

Abstract

Perimortem caesarean section presents a unique opportunity to successfully resuscitate a pregnant woman who has suffered cardio-vascular collapse, and potentially save the fetus as well. Outcomes for cardio-pulmonary resuscitation have been reported to improve with ‘emptying of the uterus’, by increasing the maternal venous return and cardiac output. The case presented is of a 40 year old multiparous woman at 30 weeks gestation admitted with systemic vasculitis, bilateral deep venous thrombosis of the lower limbs, with gangrene of the distal phalanx of the index finger on the right, and thrombocytopenia. She suffered acute cardio-pulmonary arrest and a perimortem caesarean delivery was done after 27 minutes of cardiopulmonary resuscitation. A live female infant was delivered and admitted to the new born unit. She was subsequently discharged with no neurological sequelae. This case highlights how decisive action for a perimortem caesarean delivery can result in good neonatal outcomes, even after exceeding the 4 minute rule.

Keywords: Perimortem caesarean section, Cardiopulmonary arrest, Maternal resuscitation