Perimortem cesarean or postmortem cesarean is a cesarean
operation to save the baby in serious situations where there is a risk of
losing the mother's life. Generally, it is an attempt that may be required in
sudden and extraordinary situations such as traffic accidents, suicide. During
the traffic accident and similar events that endanger the life of the mother,
necessary resuscitation (interventions such as heart massage, etc.) is
performed so that the mother does not lose her life. However, in case the
mother's heart and respiratory functions do not return, the baby is taken out
of the mother's womb by cesarean surgery in order not to lose the baby. The
time from the stopping of the mother's heart to the surgical removal of the baby
is very important. When this period is too long, even if the baby is surgically
removed, the survival rate is very low. However, there are babies that are
taken from the mother's womb and continue to live without any problem shortly
after the mother's heart stops. Of course, this surgery is done when the baby
is big enough to live. In general, in pregnancies less than 24 weeks, even if
the baby is born, this surgery is not applied because there is not much chance
to live.
Although it is unclear how often the cardiac arrest, that is,
the stopping of the heartbeat, occurs during pregnancy, it is estimated to be
one in about 30,000 pregnancies. Sometimes it is caused by sudden situations
such as traffic accident, suicide attempt, natural disaster; sometimes it can
occur in pregnant women observed in intensive care due to serious heart disease
and similar diseases. Thromboembolism, amniotic fluid embolism, bleeding,
trauma, allergy are other causes.
In some published studies, it has been reported that
post-mortem cesarean is beneficial in terms of saving the life of the mother as
well as saving the life of the baby. Since the large uterus with a baby presses
on the large vessels in the abdomen, it prevents cardiovascular circulation and
reduces the success of cardiopulmonary resuscitation applied to the mother.
Following the intake of the baby, the pressure on the vessels disappears and
the chances of the mother to begin cardiovascular circulation increase. In
addition, with the contraction of the uterus after cesarean, more blood will
pass into the mother's bloodstream. In pregnancies less than 24 weeks, that is,
if the baby is born, but has no chance to live, the size of the uterus is low
and the weight of the uterus is not considered to prevent the mother from circulating
due to the lack of pressure on the large vessels in the abdomen. Therefore,
surgery is not expected to benefit the mother under this week. Although the
American Heart Association (AHA) reports that the cesarean section, which is
applied between 20-23 weeks, can be beneficial in terms of ensuring the
circulation of the mother, there is not enough data to support this. Therefore,
the general acceptance is that perimortem cesarean is not applied in
pregnancies less than 24 weeks, as it will not benefit the mother and the baby.
When should
perimortem cesarean be applied?
If the resuscitation (CPR) applied to the mother whose heart
and respiratory functions are stopped, that is, if the mother's spontaneous
heartbeat does not start, perimortem (postmortem) cesarean is performed. If
resuscitation is successful, that is, if the mother's heartbeat begins,
cesarean is not performed.
In order for the baby to have the greatest chance of survival
and minimal risk of neurological sequela, cesarean surgery should be started 4
minutes after the cardiac arrest occurs and the baby should be taken out in the
5th minute. In other words, in cesarean surgery, taking the baby should be done
in as little as 1 minute. Healthy babies have also been reported as a result of
surgeries performed for longer periods, but the rate is decreasing. Cardiac
massage should be continued before and during the operation. It is not
recommended to take care of the baby's heartbeat before the operation because
it will waste time. In addition, healthy babies who have returned to life after
birth have been reported, even if fetal heartbeat is not observed. In order not
to waste time, surgery is performed by applying sterility as much as possible
in the place where the heart massage is applied before the mother moves to the
operating room.
Factors
affecting the baby's chances of survival in postmortem cesarean delivery:
- As the gestational week increases, the chance of the baby
to live and the chance of not developing neurological sequelae increases.
- The period from stopping the heart and breathing until
delivery (this is the most important factor)
- The effectiveness of resuscitation applied to the mother
- Neonatal intensive care unit and neonatologist
Related Posts
STITCHES AFTER SURGERY
Scar is the fibrous tissue that occurs after skin injury or
after cutting the skin in surgeries
PAIN AFTER CESAREAN DELIVERY
Like any surgery, there is a certain degree of pain after
cesarean surgery. However, it is easi
WHY IS THE CESAREAN DELIVERY RATE INCREASING?
- Increased old cesarean section: The cesarean rate increases
because patients who had previous 
USING CORSET AFTER CESAREAN OR NORMAL BIRTH
Concerns such as umbilical sagging, abdominal fat, and navel
stay are common after normal birth
WOUND INFECTION AFTER CESAREAN
Infection at the seam after cesarean section is a condition
that is seen approximately 5%. Find
CESAREAN STITCHES
In cesarean operation, the operation is ended by putting
stitches in layers in various tissues
