@article{ref1, title="Perimortem cesarean delivery: injury-free survival as a function of arrest-to-delivery interval time", journal="Obstetrics and gynecology", year="2014", author="Benson, Michael D. and Padovano, Alexander and Bourjeily, Ghada and Zhou, Ying", volume="123", number="Suppl 1", pages="137S-137S", abstract="INTRODUCTION: Currently, cardiopulmonary resuscitation of pregnant women in the third trimester is informed by the "4-Minute Rule." Cesarean delivery is begun at 4 minutes after the arrest if the mother is not responding to resuscitation so that the fetus can be delivered in the next minute, yet this guideline has never had much empirical support.

METHODS: All English language case reports of perimortem cesarean deliveries through the present (N=53) were abstracted into an Excel spreadsheet for statistical analysis to examine the relationship of time intervals to key outcomes.

RESULTS: For mothers, the mean time from arrest to birth for injury-free survivors was 9.44 minutes, whereas for those who died, it was 24.7 minutes (P=.016). For newborns, the mean for injury-free survivors was 10.08 minutes, whereas for those who died, it was 20.29 minutes (P=.035). Mean skin incision to birth interval was 3.94 minutes (standard deviation 5.95). No discontinuity in injury-free survival rates was noted with a 5-minute arrest to delivery interval. Injury-free survival for both mothers and newborns decreased in a roughly linear fashion as the time from arrest to delivery increased.

CONCLUSION: With a direct relationship of increasing injury and mortality for both mother and neonate with increasing arrest to delivery intervals, cesarean delivery should be an integral part of cardiopulmonary resuscitation in the third trimester. These data do not support a 4-minute delay to evaluate resuscitation nor a 1-minute incision to delivery time.

Language: en

", language="en", issn="0029-7844", doi="10.1097/01.AOG.0000447111.61415.4f", url="http://dx.doi.org/10.1097/01.AOG.0000447111.61415.4f" }