Yesterday we met the tragic outcome that a born baby had by postmorteal caesarean section practiced to his mother, who died due to cardiac arrest at home. The newborn, who was resuscitated by emergency services after caesarean section and taken to a hospital, unfortunately has failed to survive.
These types of emergencies are extremely rare, but the speed in decision making as well as resuscitation maneuvers both the fetus and the mother, can increase the chances of survival of one, or even both.
Caesarean section in extreme conditions
- The postmortem caesarean section is the surgical intervention performed on a pregnant mother who has died because of an accident or during childbirth, and whose baby could survive outside the mother's womb.
Historically, it is one of the oldest operations carried out and today, doctors have an ethical duty to practice it to save the baby's life, taking into account that the ideal is to do it in the five minutes following the maternal death.
- Perimórten caesarean section is another type of caesarean section that is performed in urgent cases in which the life of the mother - and therefore of the baby - is in danger.
In the sad case with which we opened the post, the Summa spokesman explained to the newspaper El País that resuscitating a mother with the baby inside is very complicated due to the pressure exerted by the child, so practicing a C-section at that time can help save both lives.
Perimorten caesarean section is not practiced if the pregnancy is less than 20 weeks, since on the one hand the fetus would be unviable outside the mother's womb and, on the other, the size of the uterus does not compromise, in principle, the mother's resuscitation maneuvers .
If the mother is between 20 and 23 weeks gestationThe objective of practicing a cesarean section will be to save the mother, not the fetus, since the viability limit outside the uterus is around 24 weeks.
From the 24th week of gestation, the perimorten caesarean section It will seek to save both the mother and the baby, but in cases where maternal death occurs, efforts will focus on saving the baby through postmortem caesarean section.
The baby's survival will depend on many factors, including the degree of prematurity. In this specific case, it was a baby of six months of gestation (between 21 and 24 weeks); a great premature, whose main problem is lung maturation.
- And there is a third category of caesarean section (which usually involves a medical ethical medical debate), which is one that is practiced postmortem to a woman whose life has been artificially prolonged, in order to be able to act for a longer time as an "incubator" for the baby.
What does the baby's survival depend on?
As we have seen, the perimorten caesarean section aims to save both the mother and the baby, while the postmortem focuses on the newborn.
The success rate of both caesarean sections will depend on many factors:
For the survival of the baby it is essential to take into account the gestational age, there are greater possibilities of viability from week 28.
Likewise, we must consider the state of health in which the fetus is, although it is recommended to practice the operation regardless of whether or not you are certain that the baby is still alive since, as explained in this health emergency manual, you should not waste time looking for the fetal heartbeat.
In the case in which the mother has died, the time elapsed between this fact and the birth of the fetus: Studies carried out by experts link the death of the baby with a late surgical intervention.
It is also important to take into account the cause of death of the mother since in those cases in which death occurs due to a chronic condition, the prognosis of the fetus's viability is usually lower than in cases of sudden death due to an accident or unexpected condition.
And finally, it is also essential to raise the prognosis of fetal life, the adequate and rapid resuscitation of the newborn. In this regard, extreme caesarean sections outside the hospital setting usually lead to a worse prognosis of viability, since neither the environment nor the technical team are the most appropriate.
