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Perimortem caesarean section
  1. Russell Boyd, Consultant,
  2. Stewart Teece, Clinical Research Fellow

    Abstract

    A short cut review was carried out to establish whether there is any evidence to show that perimortem caesarean section in the third trimester can save the life of the child or mother. Altogether 1210 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are tabulated. A clinical bottom line is stated

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    Report by Russell Boyd,ConsultantSearch checked by Stewart Teece, Clinical Research Fellow

    Clinical scenario

    A 35 year old pregnant woman is brought into the resuscitation room of the emergency department in established cardiac arrest of three minutes duration. Full basic life support has been present since arrest; initial application of advanced protocols has not re-established circulation. You wonder whether emergency caesarean section could be life saving for either fetus or mother.

    Three part question

    In [a third trimester pregnant female in cardiac arrest] is [emergency caesarean section effective] at [improving outcome for mother or fetus]?

    Search strategy

    Medline 1966–04/02 using the OVID interface. [{exp heart arrest OR exp cardiopulmonary resuscitation OR exp resuscitation OR cardiac arrest.mp OR resuscitation.mp OR perimortem.mp} AND {exp cesarean section OR cesarean.mp OR caesarean.mp OR cesarian.mp OR pregnan$.mp OR gravid$.mp OR uterine.mp}] LIMIT to human AND English Language

    Search outcome

    Altogether 1210 articles were identified, one of which was a summary of case reports up to 1985. This is summarised in table 4. Thirteen were case reports after 1985. The remaining 1196 reports were excluded as they were either case reports pre-1985 or failed to answer the three part question.

    Table 4

    Comment(s)

    Of the 15 cases reported after 1985 there were six maternal and 11 fetal survivors (including one set of twins), four of these cases had survival of both parties. Success rates seem high but reporting bias will be strongly influential in cases of this type, with only two of the 13 papers reporting loss of both mother and child in three cases. Although there is no quality evidence in this field, and there is no chance of controlled trials.

    Report by Russell Boyd,ConsultantSearch checked by Stewart Teece, Clinical Research Fellow

    References

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