title: Out-of-Hospital Perimortem Cesarean Section as Resuscitative Hysterotomy in Maternal Posttraumatic Cardiac Arrest.
abstract: The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early "separation" between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC) in the mother. This treatment, called Perimortem Cesarean Section (PMCS), is now termed as Resuscitative Hysterotomy (RH) to better address the issue of an early Cesarean section (C-section). This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR) maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C) section of a foetus at 36 weeks of gestation after the mother's traumatic cardiac arrest. Despite the negative outcome of the mother, the choice of performing a RH seems to represent up to date the most appropriate intervention to improve the outcome in both mother and foetus.
authors.affiliation: Anaesthesia and Intensive Care Unit 2, Sant'Anna Hospital, San Fermo della Battaglia, 22020 Como, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gatti
authors.affiliation: Anaesthesia and Intensive Care Unit 2, Sant'Anna Hospital, San Fermo della Battaglia, 22020 Como, Italy.
authors.forename: Marco
authors.identifier: 0000-0002-3213-7429
authors.initials: M
authors.lastname: Spagnoli
authors.affiliation: Anaesthesia and Intensive Care Unit 2, Sant'Anna Hospital, San Fermo della Battaglia, 22020 Como, Italy.
authors.forename: Simone Maria
authors.initials: SM
authors.lastname: Zerbi
authors.affiliation: Anaesthesia and Intensive Care Unit 1, Sant'Anna Hospital, San Fermo della Battaglia, 22020 Como, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Colombo
authors.affiliation: Anaesthesia and Intensive Care Unit 2, Sant'Anna Hospital, San Fermo della Battaglia, 22020 Como, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Landriscina
authors.affiliation: Bergamo 118 Operative Dispatch Center, Azienda Regionale Emergenza Urgenza (AREU), Via Campanini 6, 20124 Milan, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Kette