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Perimortem Caesarean Section - Every Second Counts! A Report of Two Cases

Perimortem caesarean section (PMCS), also referred to as resuscitative hysterotomy, is a caesarean section done during maternal cardiac arrest with the ultimate goal to assist maternal resuscitation with a good foetal outcome. Here, we present a report of two cases of PMCS performed in the setting of maternal cardiac arrest in a tertiary care hospital. Both the mothers had underlying cardiac disease and the cause of cardiac arrest was pulmonary embolism in first case and arrhythmia in the other. When there was no return of spontaneous circulation (ROSC) by 5 minutes of resuscitation, PMCS was done at the place of the cardiac arrest. The patients were made supine, left uterine displacement was done and cardio-pulmonary resuscitation (CPR) was continued. The abdomen and the uterus was opened by a scalpel via a midline vertical incision. The baby was handed over to the paediatrician. CPR was continued while the surgery was taking place. The mothers could not be revived in any of the cases, but babies were resuscitated well and later discharged in healthy condition. Clinicians should be aware of the need of PMCS in case of cardiac arrest in pregnant women at or above 20 weeks of gestation.