0071643192.pdf

CONTRAINDICATIONS

■ None

TECHNIQUE

■ Obtain radiologic shunt series, which includes AP/lateral skull, AP chest,

and AP abdominal X-rays to evaluate for kinking, disconnections or breaks

in catheter.

■ Palpate the shunt along temporal area of head. Compress the shunt reser-

voir. The reservoir should refill over 15–30 seconds.

■ A head CT may show ventricular dilation, which suggests shunt obstruc-

tion. A comparison film is useful.

COMPLICATIONS

None

INTERPRETATION OFRESULTS

■ If the valve fills slowly (>30 seconds) and can be compressed easily, the

obstruction is proximal to the valve. If the valve is not compressible, block-

age is either at the valve or distal to it.

■ Patients with VP shunt infections require directed antibiotic therapy.

Often the shunts must be removed.

PERIMORTEM CESAREAN SECTION

INDICATIONS

■ Cesarean delivery must be considered in any woman who suffers a cardiac

arrest after 24 weeks’ gestation and is unresponsive to brief resuscitation.

■ Cesarean section performed within 5 minutes of death of the mother usu-

ally results in an excellent neonatal outcome; from 5 to 10 minutes, good;

from 10 to 15 minutes, fair; and from 15 to 20 minutes, poor.

CONTRAINDICATIONS

■ Relative:

■ Performance of the procedure before the point of fetal viability at

approximately 24 weeks is not indicated.

■ Absence of obstetric backup immediately at hand

TECHNIQUE

■ CPR should be begun at the time of maternal cardiac arrest and be contin-

ued until after delivery of the infant.

■ A midline vertical incision is made through the abdominal wall extending

from the symphysis pubis to the umbilicus and carried through all abdom-

inal layers to the peritoneal cavity.

■ A small (approximately 5 cm) vertical incision is made through the lower

uterine segment until amniotic fluid is obtained or until the uterine cavity

is clearly entered.

■ The infant is then gently delivered, the mouth and nose suctioned, and

the cord clamped and cut. The infant may require active resuscitation

measures including bag-valve mask, intubation, CPR, and/or administra-

tion of medications including epinephrine, naloxone, dextrose 10%, IVF,

or bicarbonate depending on the situation (see Figure 19.9).

PROCEDURES AND SKILLS

In pregnant women with

cardiac arrest and unknown

gestational age, if the fundus

of the uterus is palpated

above the umbilicus, assume

that the fetus is viable.

There is no evidence that

perimortem C-section worsens

maternal outcome, and there

are both theoretical reasons

and some evidence suggesting

it may improve maternal

outcome.