Factors Affecting Fetal Survival Following Cesarean Section of a Pregnant Woman with a History of Significant Trauma

Description

Following significant maternal trauma it may be necessary to deliver the fetus by cesarean section if the mother is in distress or dying. The risk of fetal morbidity and mortality are affected by a number of clinical factors and management decisions.

Definition of maternal distress – one or both of the following:

(1) systolic blood pressure < 90 mm Hg (shock)

(2) acute decompensation

Factors affecting survival:

(1) fetal heart tones

(2) gestational age

(3) time to delivery

Factor	Favorable	Unfavorable
fetal heart tones	present	absent
gestational age	>= 26 weeks	< 26 weeks
time to delivery with maternal distress	immediate	delayed
time to delivery after maternal death	see below	see below

Time to Delivery After Maternal Death	Prognosis
< 5 minutes	excellent
5 – 10 minutes	good
10.1 – 15 minutes	fair
15.1 – 20 minutes	poor
> 20 minutes	unlikely

Additional findings:

(1) Fetal survival is independent of maternal distress and injury.

(2) The survival in the report of Morris et al was 75% for fetuses with gestational age >= 26 weeks.

(3) Even if the fetus survives the morbidity (neurologic, respiratory, etc.) may be high.

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Description

Specialty

ICD-10