1. Peri-Mortem Cesarean Section
Prepared by Shane Barclay

2. Objectives
Review indications for peri-mortem C-section. Outline technique.

3. You had to do a peri-mortem Cesarean section
What if….
You had to do a peri-mortem Cesarean section

4. Biggest nightmare in the ER
Even contemplating a c-section in the ER eclipses any airway or other intervention nightmare one could imagine having to perform. May you never have to do this, especially in a rural ER or other setting! But, just in case, here is what you should know!

5. Peri-mortem C-section (PCS)
What settings could you possibly encounter this?
Any pregnant woman who suffers a cardiac arrest from any cause.

6. Peri-mortem C-section (PCS)
Traditional teaching is that PCS is indicated to increase survival of the mother, not the baby. Procedure increases maternal survival because venous return increases once uterus is no longer compressing IVC. And, with no blood flow to uterus, there is more blood flow to the maternal heart.

7. Peri-mortem C-section (PCS)
Perform on 24+ week gestation. (fundus above umbilicus) Perform immediately after maternal cardiac arrest. For an infant > 24 weeks, survival is around 70% if delivered within 4 minutes after cardiac arrest and drops precipitously after that. Survival drops to < 3% by minutes. For the mom, even after 4 minutes of CPR, resuscitative hysterotomy will have survival benefits to the mother.

8. PCS Technique
CPR should be performed throughout the c-section and afterwards. All you need is a #10 scalpel, scissors and your hands.
Should take less than ONE Minute to complete.

9. PCS Technique 1. Clean abdomen.
2. Vertical incision from xiphoid to pubis
3. Cut through s.c. tissue to get to peritoneal wall.
4. Use fingers to bluntly dissect to the peritoneum.
5. Cut small vertical incision in lower peritoneal wall.
6. Extend with scissors to top of peritoneum.

10. PCS Technique
7. Deliver the uterus outside the abdominal wall. 8. Cut vertically into lower uterine wall. 9. Extend with scissors up until baby is visible. 10. Deliver baby. 11. Clamp and cut cord. 12. Pack uterus and abdominal cavity with towels.

11. PCS Technique
On the web page are videos showing the technique.

12. The END.