Postmortem cesarean section with infant survival: a case report of an HIV-infected patient.
Postmortem cesarean sections are rare events, but modern technology is forcing society to explore the definition of viability and the legal rights of both mother and fetus that ultimately will affect the frequency and use of this rare operation. Since the Human Immunodeficiency Virus (HIV) prevalence rate and the number of critically ill obstetrical patients with Acquired Immunodeficiency Syndrome (AIDS) continues to rise, it is reasonable to assume more patients and physicians may be confronted by issues concerning fetal and maternal rights and other considerations in perimortem delivery. A 33-year-old woman, at 27 weeks' gestation, with fulminant AIDS was admitted to the intensive care unit (ICU) in respiratory distress. As her condition deteriorated the complex problem of caring for both mother and fetus emerged. A patient advisory panel explored the issues with the patient, her family, and her health care team. Eventually a peri/postmortem cesarean section was performed on the mother when she suffered an acute fatal cardiorespiratory arrest. With the prevalence of AIDS increasing and with most women not being tested prior to pregnancy, many obstetricians will be confronted with new medical and legal challenges. Establishing comprehensive medical management for the critically ill obstetrical patient and understanding the legal rights of both patients (mother and fetus) will help avoid conflicts and potentially improve survival.
Esposito
M A
MA
Sinai Hospital, Baltimore, USA.
DeLony
R
R
Goldstein
P J
PJ
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D002585:Cesarean Section; D002651:Child Advocacy / Q000331:legislation & jurisprudence; D004992:Ethics, Medical; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest; D006801:Humans; D007231:Infant, Newborn; D010344:Patient Advocacy / Q000331:legislation & jurisprudence; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011256:Pregnancy Outcome