Question 2 of 4

Perimortem cesarean section is recommended only when:

An obstetrician is available to perform the procedure.

Fetal heart sounds are present.

Resuscitation of the mother has stopped or been determined to be futile.

The fetus is at 26 weeks of gestation or greater.

Ultrasound confirms fetal gestation time and viability.

Perimortem cesarean section in the ED should be performed if uterine size exceeds the umbilicus and fetal heart tones are present. Bedside ultrasound may also be used to quickly assess the presence of a fetal heart rate. No physician has been found liable for performing a perimortem cesarean. Time since maternal circulation ceased is the critical factor in fetal outcome. It is a difficult decision for the clinician to make but hesitation decreases chances for fetal survival. Reports show that 70% of children who survive perimortem cesarean sections are delivered in less than 5 minutes of ED arrival. Rapid extraction avoiding further injury to the mother or fetus is the goal. Maternal CPR is continued. A vertical incision is made from umbilicus to pubis. The bladder is retracted and a 5 cm vertical incision is made in the lower uterus and extended superiorly to the fundus with scissors, using one's fingers to protect the fetus.

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