1. TEMPLATE DESIGN © 2008 www.PosterPresentations.com Perimortem Caesarean section ( PMCS) ;Validating the technique Ellepola Hasthika 1, Seneviratna S 2, Haran Mano 1  2 1 Department of Obstetrics and Gynaecology Logan Hospital, QLD, Australia 2 Schools of Medicine, Griffith University, QLD, Australia Introduction Cardiopulmonary arrest during pregnancy presents a unique clinical scenario involving two patients; the mother and the fetus Management of these patients demands a rapid multidisciplinary approach Basic and advanced cardiac life support algorithms should be implemented The physiological and anatomical changes of pregnancy may require a perimotem caesarean (PMCS) delivery PMCC is a rare event; only few Obstetricians would have experience in performing this life saving operation. OBJECTIVES Validate the technique of this rare Obstetrics procedure based on case series We describe two cases of cardiac arrest in pregnancy in which a PMCS was performed as part of the resuscitation process The authors of this study has personally been involved in one or both of the case series Clinical cases Case 1  A 36 year old uncomplicated mulipara was in active labour  Subsequently; experienced a cardiopulmonary arrest secondary to amniotic fluid embolism (AFE).  Code blue was called and cardiopulmonary resuscitation (CPR) commenced  To facilitate on going CPR perimotem caesarean section was performed in the birthing suit an aid of a scalpel blade Case 2  A 24 years old uncomplicated primi in labour was fully dilated and had a cardiac arrest in the birthing suite  CPR was commenced and with in four minutes of unsuccessful resuscitation a PMCS was performed  Due to the clinical urgency fetus was delivered with an aid of a scalpel blade Findings In both occasions to facilitate the ongoing resuscitation Obstetrics team performed a PMCS approximately between 4-5 minutes since commencement of CPR Scalpel blade with out the handle was the only surgical instrument that was used. Skin to delivery time was between 15 to 30 seconds Results Findings In both occasions to facilitate the ongoing resuscitation Obstetrics team performed a PMCS approximately between 4-5 minutes since commencement of CPR Scalpel blade with out the handle was the only surgical instrument that was used. Skin to delivery time was between 15 to 30 seconds Technique Transverse skin incision performed with the scalpel blade with out the handle and blunt dissection of the subcutaneous tissue The fascial incision extended bluntly by inserting the fingers of each hand under the fascia and then pulling in a cephalad-caudad direction Rectus muscle layer and the peritoneum separated bluntly by the operator’s fingers Lower transverse incision made on the uterus with out reflecting the bladder Once the fetus delivered in both occasions atonic uterus noted uterine closure performed in two- layer, continuous closure with absorbable suture Skin approximated with interrupted stitches using delayed absorbable synthetic sutures Conclusions References Time lines of the intervention is of extreme importance for both maternal and fetal outcome Time-consuming activities such as fetal monitoring and transportation to the operating theatre reduce the chances of maternal and neonatal survival and should be avoided Conclusion PMCC which is potentially a lifesaving procedure for both mother and baby Could be promptly performed effectively even in a suboptimum location with minimum surgical instruments OPTIONAL LOGO HERE 1 Zelop, CM, Grimes EP. Cardiopulmonary Resuscitation in Pregnancy. In: The textbook of Emergency Cardiovascular Care and CPR Philadelphia 2009. p.538 2Lewis, G. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: Reviewing Maternal Deaths to make Motherhood Safer 2003- 2005. The Seventh Confidential Enquiry into Maternal Deaths in the United Kingdom. RCOG Press. 2007