Maternal resuscitation - Role of perimortem cesarean delivery (PMCD)

Background: this study was undertaken to address the topic which evokes mixed reactions from the medical professionals and patients and their relatives. there is no local data,even retrospective available on this very important aspect of cardiopulmonary resuscitation. a pregnant collapsed patient requires special considerations and adjustments for cardiopulmonary resuscitation and this study highlights the assessment of data of this very rare condition which involves two patients' mother and fetus. aim: to determine the causes and outcome of maternal cardiac arrest and relation of perimortem cesarean section timing with maternal and fetal outcome. study design: retrospective case series. place and duration: multicentre data for the study was collected from january 2010-december 2015 from pakistan naval hospital shifa,combined military hospital kharian and armed forces institute of cardiology/ national institute of heart disease rawalpindi pakistan. methodology: hospital records of consecutive pregnant patients diagnosed with cardiac arrest were evaluated retrospectively. primary outcome was maternal and neonatal survival. secondary outcome was timing of perimortem cesarean section including arrest to delivery time and relation to survival. results: a total of 15 patients were identified from hospital records. mean age was 34.4± 5.2 yrs period of gestation at time of arrest 35.3±2.0 weeks. majority of patients were unbooked 10(66.6%) and place of arrest was labor room 6(40%),ward 4(26.7%),intensive care unit 3(20%) and emergency room 2(13.3%) respectively. maternal survival was in 4(26.7%) and 5(35%) neonates survived. relation between timing of pmcs and maternal and neonatal survival was statistically significant .p value 0.035 and 0.0.05 for maternal and neonatal survival. conclusion: maternal cardiopulmonary arrest is a rare occurrence but involves intense emotions both for the victim's family as well as the team providing care. resuscitation guidelines and necessary equipment for performing pmcd should be available at all emergency departments and labor wards.