title: Care of the Critically Ill Pregnant Patient and Perimortem Cesarean Delivery in the Emergency Department.
abstract: BACKGROUND
  Maternal resuscitation in the emergency department requires planning and special consideration of the physiologic changes of pregnancy. Perimortem cesarean delivery (PMCD) is a rare but potentially life-saving procedure for both mother and fetus. Emergency physicians should be aware of the procedure's indications and steps because it needs to be performed rapidly for the best possible outcomes.
  
  
  OBJECTIVE
  We sought to review the approach to the critically ill pregnant patient in light of new expert guidelines, including indications for PMCD and procedural techniques.
  
  
  CONCLUSIONS
  The prevalence of maternal cardiac arrest and survival outcomes of PMCD in the emergency department setting are difficult to estimate. Advanced cardiovascular life support protocols should be followed in maternal arrest with special considerations made based on the physiologic changes of pregnancy. The latest recommendations for maternal resuscitation are reviewed, including advance planning, rapid determination of gestational age, emergent delivery, and postprocedure considerations for PMCD.
  
  
  CONCLUSIONS
  Maternal resuscitation requires knowledge of physiologic changes and evidence-based recommendations. PMCD outcomes are best for both mother and fetus when the procedure is performed rapidly and efficiently in the appropriate setting. Emergency physicians should be familiar with this unique clinical scenario so they are adequately prepared to intervene in order to improve maternal and fetal morbidity and mortality.
authors.affiliation: Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Healy
authors.affiliation: Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Dana E
authors.initials: DE
authors.lastname: Kozubal
authors.affiliation: Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Horn
authors.affiliation: Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.affiliation: Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California.
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Chan
authors.affiliation: Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Jacob W
authors.initials: JW
authors.lastname: Ufberg
mesh_terms: D022561:Advanced Cardiac Life Support / Q000379:methods*; D002585:Cesarean Section / Q000379:methods*; D016638:Critical Illness; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy*
keywords: emergency department; maternal resuscitation; perimortem cesarean delivery