Q: If a pregnant patient has a cardiac arrest and the uterine fundus is noted to be at or above the umbilicus, perimortem cesarean should be initiated at?
A) Two minutes
B) Four minutes
C) Eight minutes
D) Fifteen minutes
E) Only if there is an unsuccessful code
Answer: B
If a pregnant patient has a cardiac arrest, it should be announced as "maternal code blue" so the obstetrical and neonatology teams can arrive at the initiation of code and can start preparing for cesarean delivery. It is recommended to have a person with a dedicated timer, and the procedure should begin at four minutes if ACLS protocol stays unsuccessful and the baby should be delivered by the end of the five minutes.
During ACLS of a pregnant patient, if the uterus is at or above the umbilicus, it should be manually displaced to the left lateral position, while CPR is performed. Another important aspect to remember is to place intravenous (IV) access above the diaphragm.
Actually, early delivery is associated with a successful outcome of the resuscitation process itself.
#ob-gyn
#cardiology
References:
1. Rose CH, Faksh A, Traynor KD, et al. Challenging the 4- to 5-minute rule: from perimortem cesarean to resuscitative hysterotomy. Am J Obstet Gynecol 2015; 213:653.
2. Doan-Wiggins L. Resuscitation of the pregnant patient suffering death. In: Cardiac Arrest: the science and practice of resuscitation medicine, Turrentine MA, Braems G, Ramirez MM (Eds), Williams and Wilkins, Philadelphia 1997. p.812.
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