Peri-mortem at Bellevue?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
i heard of someone speaking about a perimortem c-section in at least two of the spots i interviewed at which had occurred in the recent past.. not sure its such a rare event nationwide
 
Members don't see this ad :)
migm said:
i heard of someone speaking about a perimortem c-section in at least two of the spots i interviewed at which had occurred in the recent past.. not sure its such a rare event nationwide
Click to expand...

Uh----yes, yes it is in spite of your overwhelming consensus of anecdotes to demonstrate otherwise.
 
migm said:
perhaps some numbers rather than quip?
Click to expand...

Sorry, but it doesn't work that way.
Your hearsay anecdotal evidence is fairly abnormal, actually.
I, like most, have never met anyone who did one.
 
Maybe someone was trying to show off, thanks for posting the numbers. Not sure why a thought inquiring on the frequency of the procedure was met with enmity
 
Mom died, baby lived. That's a peri-mortem c-section (though I have no first hand knowledge of this case, beyond the same news report you read). Great save, guys. :thumbup: Saves like that don't come along too often. Despite that, it's tragic the parents weren't able to be saved. My condolences go out to all those involved in any way. That's Emergency Medicine for you: all the highs and the lows, all rolled into one.
 
When I was doing rotations as a 4th year med student, I once heard from an attending that knew another attending that did one. So there you go, hearsay knowledge of one performed in Pittsburgh sometime in the last 10+years. Sorry you were jumped on, would've been easier to just say they're incredibly rare and even to have second-hand knowledge or tertiary knowledge of one.
 
Had an attending in residency who, when she was a resident in Philly (I forget where - maybe Jeff), was part of one. I don't recall if the baby lived or died. She said they almost had a second one, but didn't cut - which was good, because the pt wasn't pregnant, but just a fatty (and dead, too).
 
Members don't see this ad :)
Apparently my home city is a really dangerous place to be preggers...

The department at my school has had at least two in the past year and a half that I know of (one during my 3rd year OB clerkship, the other a bit after my EM month). However, the procedures themselves were mainly performed by OBs who ran down upon pre-arrival notification, so I'm not sure if they count for the purpose of this discussion or not.
 
My non-trauma center had one a couple months ago. The ONLY one I have ever been peripherally involved in other than one legendary case from my residency that people reference in hushed whispers.

It was exceptionally traumatic for the staff, and the OB who arrived 30 seconds before the patient did and actually did the section. I have talked to her several times, and it has deeply affected her. Of the 3 ED docs on that night, one is a grizzled old-timer nearing retirement who trained as a surgeon. He'd been peripherally involved in one, years ago. The other 2 docs were both 6 months out of residency and damn good. The OB came. The neonatologist came. It was a full-court, exhausting press.

Both died.
Now, mom had been down more than the ATLS-4-minute rule, but the medics weren't just going to call it. My docs actually got the baby back briefly, but it didn't make it.

I got to help lead the critical incident debriefing. It was horrible.
My thoughts are with the crew at Bellevue, because that's the only explanation of how the baby lived.
 
Never done one. Never known anyone that did. In med school I sat through a lecture on it with something close to 40 attendings and 50 residents and only one person had even seen one.
 
They announced that the baby in the original post died. Too bad.
 
gutonc said:
Unsurprising. Per the original story it was a 24 weeker. Even under the best of circumstances the odds of survival suck. If one is to believe this study, 30% or so.
Click to expand...

Ah, I looked for it but never saw the gestational age. Articles seemed to imply it was more. Oh well.

Two people in the BMW that hit them - walked away. Probably wearing seatbelts.

Driver of cab - walked away with minor injuries. Probably wearing seatbelt.

Two passengers in the back. Pregnant woman was ejected, man was pinned. Both (three) died. Seatbelts? Probably not. People who wear seatbelts every other time forget to wear them in cabs. Bad idea.


As an aside, can someone be charged with murder of a fetus if it was past a GA where it would at least be viable?
 
Last edited:
engineeredout said:
Ah, I looked for it but never saw the gestational age. Articles seemed to imply it was more. Oh well.

Two people in the BMW that hit them - walked away. Probably wearing seatbelts.

Driver of cab - walked away with minor injuries. Probably wearing seatbelt.

Two passengers in the back. Pregnant woman was ejected, man was pinned. Both (three) died. Seatbelts? Probably not. People who wear seatbelts every other time forget to wear them in cabs. Bad idea.


As an aside, can someone be charged with murder of a fetus if it was past a GA where it would at least be viable?
Click to expand...

In California yes. That's why in the Scott Peterson case he was found guilty on two counts of first degree murder.
 
DeadCactus said:
Seems like answering that question would be a HIPPA violation...
Click to expand...
Correct.

I once witnessed a perimortem c-section during my paramedic clinicals. Amazing how fast the OB (who happened to be in-house) cut her open. Baby died. Woman had a history of seizures and had one while sitting in the tub. Caused her to drown. Only 20 something years old.
 
southerndoc said:
Correct.

I once witnessed a perimortem c-section during my paramedic clinicals. Amazing how fast the OB (who happened to be in-house) cut her open. Baby died. Woman had a history of seizures and had one while sitting in the tub. Caused her to drown. Only 20 something years old.
Click to expand...

We had a lecture on this during residency one conference day. The OB that was lecturing said they could get in there in less than 90 seconds - start with a vertical midline incision from the subxiphoid to pubic symphysis.
 
This is such an interesting case. Sad to learn the infant passed away today. I was wondering if this was a crash C-section myself. The paramedics definitely did the right thing though. Dad was dead, went to the nearest ER which was Beth Israel. Mom with child was sent to nearest Level 1 trauma center in Bellevue. Definitely have a sophisticated NICU there, and would be the right place to do a crash C-section. Makes me wonder though.. by protocol, if pregnant mom has no vitals in field does she go to the nearest hospital (like husband) or the nearest level 1?
 
Temple University Hospital in Philly had a peri-mortum c-section in the past year, I don't know if anyone from EM did it. But the case made the news for other reasons.
 
ERdocSGU said:
This is such an interesting case. Sad to learn the infant passed away today. I was wondering if this was a crash C-section myself. The paramedics definitely did the right thing though. Dad was dead, went to the nearest ER which was Beth Israel. Mom with child was sent to nearest Level 1 trauma center in Bellevue. Definitely have a sophisticated NICU there, and would be the right place to do a crash C-section. Makes me wonder though.. by protocol, if pregnant mom has no vitals in field does she go to the nearest hospital (like husband) or the nearest level 1?
Click to expand...

Totally irrelevant to the topic at hand but those two hospitals are 10 blocks apart. At 1am the difference in transport times was probably 1 or 2 minutes.
 
ERdocSGU said:
This is such an interesting case. Sad to learn the infant passed away today. I was wondering if this was a crash C-section myself. The paramedics definitely did the right thing though. Dad was dead, went to the nearest ER which was Beth Israel. Mom with child was sent to nearest Level 1 trauma center in Bellevue. Definitely have a sophisticated NICU there, and would be the right place to do a crash C-section. Makes me wonder though.. by protocol, if pregnant mom has no vitals in field does she go to the nearest hospital (like husband) or the nearest level 1?
Click to expand...

Similar situation when I was on trauma. Mom was (barely) alive after an MVA (3rd trimester), but she was transported to the closest hospital (non-trauma center, rural ED) because the rules prohibited taking a pregnant female on a chopper. The ED did the section at a hospital that definitely is not equipped to handle a crashing neonate and mom was finally flown to us but completely arrested en route. There was a big debate afterwards on whether or not a pregnant trauma should really be considered a pregnant trauma for the purposes of flying or rather Trauma first, pregnant second, similar to how you treat a pregnant woman normally (mom first, fetus 2nd). Argument against is that if she goes into labor, there is no room in the back of a chopper to deliver a baby.
 
gutonc said:
Totally irrelevant to the topic at hand but those two hospitals are 10 blocks apart. At 1am the difference in transport times was probably 1 or 2 minutes.
Click to expand...

I wasn't there but from the news reports it sounds like mom had a pulse when she got in the ambulance, dad was in arrest when extricated. So it sounds like the protocols were followed sending the live one to the trauma center and the dead one to the closest ER.
 
I saw a video of a peri-mortem section performed on a military base in the Middle East (I'm Air Force). A pregnant civilian was shot in the head, brought to the hospital, and an OB performed the section within a few seconds. Both mother and baby died. Other than that one instance I have never known any physician to perform one.
 
Apollyon said:
We had a lecture on this during residency one conference day. The OB that was lecturing said they could get in there in less than 90 seconds - start with a vertical midline incision from the subxiphoid to pubic symphysis.
Click to expand...


I have personally been involved in one perimortem section. Baby lived, mom died. Transverse incision. Took less than a minute to get the baby out.
 
You must log in or register to reply here.
Next unread thread

Similar threads

theWUbear
Importance of pubmed indexing in publication of small review articles vs publication in periodicals
Replies
3
Views
2K
theWUbear
theWUbear
SpacemanSpifff
Tandem resuscitative hysterotomy and thoracotomy in peripartum cardiomyopathy-mediated cardiac arrest
Replies
17
Views
2K
deleted109597
D
L
Bellevue toxicology rotation
Replies
3
Views
6K
mdmacros
mdmacros
Angry Birds
Peripheral-central IV line
Replies
26
Views
4K
MechEDoc
MechEDoc
Angry Birds
How critical is BC (board certification) for an academic job during your BE (board eligible) period?
Replies
17
Views
2K
Angry Birds
Angry Birds
Top