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Re: Post-mortem C/S From: Lynn D. Montgomery, M.D. (apgar10@montanadsl.net) Tue Nov 22 09:35:40 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: William D. McIntosh, M.D: "Re: Homebirths" Previous message: Dean Huffman .: "Re: OB: Post-mortem C/S" In reply to: Garry E. Siegel, M.D.: "OB: Post-mortem C/S" Next in thread: RModugno@aol.com: "Re: OB: Post-mortem C/S" Garry, Tough case, but I agree with Bob - there is nothing in your case that could have been done. The parameters that I have followed are based on the paper by Droegemueller and others regarding the "4 minute limit", which basically addresses maternal perfusion during CPR - the fact that optimal chest compressions cannot adequately perfuse with the pregnant uterus present. As such, the "4 minute limit" addresses maternal physiology and the fact that if resuscitative efforts do not revive the patient within 4 minutes, the uterus should be evacuated. This does not address fetal status at all. Fetal outcome is extremely varied as case reports over the years have demonstrated. The debate has always been what gestational age to chose and this has never really been defined based on data. I think each physician must chose a "cut-off". Bob's of 30 weeks is very reasonable. I have always used 24 weeks and actually did one at 23 weeks for a patient who went down at home with a totally unexplained arrest. Got inside and she had blown the fetus through the top of the fundus and had a belly full of blood. Cross clamped the top of the uterus and she was resuscitated, although the final outcome was poor. Who ever said that only those witnessed, within a health care facility have much of a chance, hit the nail on the head... Lynn -- Lynn D. Montgomery, M.D. Maternal-Fetal Medicine, OB/GYN Rocky Mountain Women's Health 2835 Fort Missoula Rd., Suite 304 Missoula, Montana, 59804 406-549-0978 fax 406-549-0987 e-mail: apgar10@montanadsl.net -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Monday, November 21, 2005 9:21 PM To: Multiple recipients of list OB-GYN-L Subject: OB: Post-mortem C/S I was called to the ER this weekend for a term patient en route who had a full cardio-pulmonary arrest, 8 1/2 months, and undergoing CPR. On arrival, she was dead, and had been undergoing CPR and been "down" (their terminology) for an hour. FHTs were absent by ultrasound upon admission, so I did not do a C/S. I couldn't really find anything in a medline about how much time one really has in these circumstances to begin a section. Any thoughts welcome. Garry -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: William D. McIntosh, M.D: "Re: Homebirths" Previous message: Dean Huffman .: "Re: OB: Post-mortem C/S" In reply to: Garry E. Siegel, M.D.: "OB: Post-mortem C/S" Next in thread: RModugno@aol.com: "Re: OB: Post-mortem C/S"

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