Perimortem C-section demands quick trip to OR.(cesarean section)(operating room)

PASADENA, CALIF. -- Get a pregnant woman with cardiac arrest to the operating room.

That is where the best hope lies for her survival and that of her fetus, said Dr. J. Gerald Quirk at the annual meeting of the Obstetrical and Gynecological Assembly of Southern California.

"A cesarean section by you in the emergency room 2 minutes after a patient is brought in by ambulance is no better than a C-section by the side of the road by EMTs [emergency medical technicians]," said Dr. Quirk, professor and chairman of obstetrics, gynecology, and reproductive medicine at the State University of New York at Stony Brook.

Potentially reversible causes of cardiac arrest during pregnancy include hemorrhage, trauma, hypoxia, hypothermia, hyper- and hypokalemia, myocardial infarction, metabolic acidosis, and iatrogenic factors such as medication or anesthesia errors. But complex physiologic and metabolic changes of pregnancy can complicate resuscitation.

"Remember, pregnancy is a high flow, low resistance state," he said.

Cardiac output is high, and 30% of cardiac output perfuses the uterus. Systemic vascular resistance is low. Airway management may be difficult. Left uterine displacement is necessary, as is application of cricoid pressure to avoid aspiration.

There is a need for increased chest wall compression force, "but it can be hard to know what that force is," said Dr. Quirk. "The patient is a risk for fractured ribs and pneumothorax."