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Section 8 - Management of Anticipated and Non-anticipated Emergencies in Pregnancy

Published online by Cambridge University Press:  06 May 2021

Edwin Chandraharan
St George's University of London
Sir Sabaratnam Arulkumaran
St George's University of London
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Obstetric and Intrapartum Emergencies
A Practical Guide to Management
, pp. 273 - 296
Publisher: Cambridge University Press
Print publication year: 2021

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Wu, S, Kocherginsky, M, Hibbard, JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynaecol. 2005;192(5):1458–61.CrossRefGoogle ScholarPubMed
Jauniaux, ERM, Alfirevic, Z, Bhide, AG, et al. on behalf of the Royal College of Obstetricians and Gynaecologists. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top guideline No. 27a. London: RCOG, 2018.Google Scholar
Doumouchtsis, SK, Arulkumaran, S. The morbidly adherent placenta: an overview of management options. Acta Obstet Gynaecol Scand. 2010;89(9):1126–33.CrossRefGoogle ScholarPubMed
Chandraharan, E, Rao, S, Belli, AM, Arulkumaran, S. The triple P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. Int J Gynaecol Obstet. 2012;117(2):191–4.CrossRefGoogle ScholarPubMed
Pinas-Carrillo, A, Chandraharan, E. Management of morbidly adherent placenta. Obstet Gynaecol Reprod Med. 2016;26:283–90.Google Scholar
Sentilhes, L, Kayem, G, Chandraharan, E, Palacios-Jaraquemada, J, Jauniaux, E; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: conservative management. Int J Gynaecol Obstet. 2018;140(3):291–8.CrossRefGoogle ScholarPubMed
Teixidor Viñas, M, Belli, AM, Arulkumaran, S, Chandraharan, E. Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple-P procedure. Ultrasound Obstet Gynecol. 2015;46(3):350–5.CrossRefGoogle ScholarPubMed
Pinas-Carrillo, A, Bhide, A, Moore, J, et al. Outcomes of the first 50 patients with abnormally invasive placenta managed using the ‘triple P procedure’ conservative surgical approach. Int J Gynaecol Obstet. 2020;148(1):6571.CrossRefGoogle Scholar
Wei, Y, Cao, Y, Yu, Y, Wang, Z. Evaluation of a modified triple-P” procedure in women with morbidly adherent placenta after previous caesarean section. Arch Gynecol Obstet. 2017;296(4):737–43. DOI: 10.1007/s00404-017-4447-0.CrossRefGoogle ScholarPubMed
Piñas Carrillo, A, Chandraharan, E. Placenta accreta spectrum: risk factors, diagnosis and management with special reference to the triple P procedure. Womens Health (Lond). 2019;15:1745506519878081. DOI: 10.1177/1745506519878081.Google ScholarPubMed
Lanoix, R, Akkapeddi, V, Goldfeder, B. Perimortem cesarean section: case reports and recommendations. Acad Emerg Med. 1995;2:1063.CrossRefGoogle ScholarPubMed
Katz, VL, Dotters, DJ, Droegemueller, W. Perimortem cesarean delivery. Obstet Gynecol. 1986;68(4):571–6.Google ScholarPubMed
Bowers, W, Wagner, C. Field perimortem cesarean section. Air Med J. 2001;20:1011.CrossRefGoogle ScholarPubMed
Marx, GF. Cardiopulmonary resuscitation of late-pregnant women. Anesthesiology. 1982;56:156.CrossRefGoogle ScholarPubMed
The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving mothers’ lives: Reviewing maternal deaths to make motherhood safer – 2003–2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH, 2007.Google Scholar
Howell, C, Grady, K, Cox, C. Managing Obstetric Emergencies and Trauma: The MOET Course Manual, 2nd ed. London: RCOG, 2007.Google Scholar
Whitten, M, Montgomery, L. Post-mortem and perimortem caesarean section: what are the indications? J Royal Soc Med. 2000;93:69.CrossRefGoogle Scholar
Capobianco, G, Balata, A, Mannazzu, MC, et al. Perimortem cesarean delivery 30 min after a laboring patient jumped from a fourth-floor window: baby survives and is normal at age 4 years. Am J Obstet Gynecol. 2008;198:e15e16.CrossRefGoogle Scholar
Oates, S, Williams, GL, Rees, GAD. Cardiopulmonary resuscitation in late pregnancy. Br Med J. 1988;297:404–5.CrossRefGoogle ScholarPubMed
O’Connor, RL, Sevarino, FB. Cardiopulmonary arrest in the pregnant patient: a report of a successful resuscitation. J Clin Anesth. 1994;6:66–8.Google ScholarPubMed
Page-Rodriguez, A, Gonzalez-Sanchez, JA. Perimortem caesarean section of a twin pregnancy: case report and review of the literature. Acad Emerg Med. 1999;6:1072–4.CrossRefGoogle ScholarPubMed
Parker, J, Balis, N, Chester, S, Adey, D. Cardiopulmonary arrest in pregnancy: successful resuscitation of mother and infant following immediate cesarean section in labour ward. Aust N Z J Obstet Gynaecol. 1996;36:207–10.CrossRefGoogle ScholarPubMed
Yeomans, ER, Gilstrap, LC. Physiologic changes in pregnancy and their impact on critical care. Crit Care Med. 2005;33(10):S256–8.CrossRefGoogle ScholarPubMed
Dijkman, A, Huisman, C, Smit, M, et al. Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency skills training? Br J Obstet Gynaecol. 2010;117:282–7.CrossRefGoogle ScholarPubMed
Warraich, Q, Esen, U. For perimortem caesarean section, the surgical knife is the most important instrument. Br J Obstet Gynaecol. 2010;117:768.CrossRefGoogle ScholarPubMed
Katz, V, Balderston, K, DeFreest, M. Perimortem cesarean delivery: were our assumptions correct? Am J Obstet Gynecol. 2005;192:1916–20.CrossRefGoogle ScholarPubMed
American Heart Association. The American Heart Association Guidelines 2005 for cardiopulmonary resuscitation and emergency cardiovascular Care. Part 10.8: cardiac arrest associated with pregnancy. Circulation. 2005;112:IV1503.Google Scholar
Mallampalli, A, Powner, DJ, Gardner, MO. Cardiopulmonary resuscitation and somatic support of the pregnant patient. Crit Care Clin. 2004;20:747–61.CrossRefGoogle ScholarPubMed
Beckett, VA, Knight, M, Sharpe, P. The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study. BJOG. 2017;124:1374–81.CrossRefGoogle ScholarPubMed
Chu, JJ, Hinshaw, K, Paterson-Brown, S. Perimortem caesarean section: why, when and how. Obstetrician & Gynaecologist. 2018;20:151–8.CrossRefGoogle Scholar
Costeloe, KL, Hennessy, EM, Haider, S, et al., Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). 2012;345:e7976.Google Scholar
Hodek, J-M, von der Schulenburg, JM, Mittendorf, T. Measuring economic consequences of preterm birth: methodological recommendations for the evaluation of personal burden on children and their caregivers. Health Econ Rev. 2011;1(1):639.CrossRefGoogle ScholarPubMed
Romero, R. Espinoza, J, Kusanovic, JP, et al. The preterm parturition syndrome. BJOG. 2006;113(Suppl 3):1742.CrossRefGoogle ScholarPubMed
Iams, JD, Berghella, V. Care for women with prior preterm birth. Am J Obstet Gynecol. 2010;203(2):89100.CrossRefGoogle ScholarPubMed
Kyrgiou, M, Athanasiou, A, Paraskevaidi, M, et al. Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. BMJ. 2016;354:i3633.CrossRefGoogle ScholarPubMed
Watson, HA, Carter, J, David, AL, et al. Full dilation cesarean section: a risk factor for recurrent second-trimester loss and preterm birth. Acta Obstet Gynecol Scand. 2017;96(9):1100–5.CrossRefGoogle ScholarPubMed
Sarri, G., Davies, M, Gholitabar, M, et al. Preterm labour: summary of NICE guidance. BMJ. 2015;351:h6283.CrossRefGoogle ScholarPubMed
Varley-Campbell, J., Mújica-Mota, R, Coelho, H, et al. Three biomarker tests to help diagnose preterm labour: a systematic review and economic evaluation. Health Technol Assess. 2019;23(13):1226.CrossRefGoogle ScholarPubMed
Kuhrt, K., Hezelgrave, N, Foster, C, et al. Development and validation of a tool incorporating quantitative fetal fibronectin to predict spontaneous preterm birth in symptomatic women. Ultrasound Obstet Gynecol. 2016;47(2):210–16.Google ScholarPubMed
Watson, HA, Carter, J, Seed, PT, et al. The QUiPP App: a safe alternative to a treat-all strategy for threatened preterm labor. Ultrasound Obstet Gynecol. 2017;50(3): 342–6.CrossRefGoogle ScholarPubMed
Liggins, GC, Howie, RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics. 1972;50(4):515–25.Google ScholarPubMed
Roberts, D, Dalziel, S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006(3):CD004454.Google ScholarPubMed
Soe, A., David, ALM, Costoloe, K, et al. Perinatal management of pregnant women at the threshold of infant viability (the obstetric perspective). RCOG Scientific Impact Paper. 2014;1:115.Google Scholar
Crowther, CA, McKinlay, CJD, Middleton, P, Harding, JE. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database Syst Rev 2015(7).CrossRefGoogle Scholar
Rodriguez, A, Wang, Y, Khan, AA, et al. Antenatal corticosteroid therapy (ACT) and size at birth: a population-based analysis using the Finnish Medical Birth Register. PLOS Med. 2019;16(2):e1002746.CrossRefGoogle ScholarPubMed
Crowther, CA, Middleton, PF, Voysey, M, et al. Assessing the neuroprotective benefits for babies of antenatal magnesium sulphate: an individual participant data meta-analysis. PLOS Med. 2017;14(10):e1002398.CrossRefGoogle ScholarPubMed
van Vliet, EOG, Nijman, TAJ, Schuit, E, et al. Nifedipine versus atosiban for threatened preterm birth (APOSTEL III): a multicentre, randomised controlled trial. Lancet. 2016;387(10033):2117–24.CrossRefGoogle ScholarPubMed
Kenyon, S., Taylor, DJ, Tarnow-Mordi, WO, et al. ORACLE–antibiotics for preterm prelabour rupture of the membranes: short-term and long-term outcomes. Acta Paediatr Suppl. 2002;91(437):1215.CrossRefGoogle ScholarPubMed
Hughes, RG, Brocklehurst, P, Steer, PJ, et al. Prevention of early-onset neonatal group B streptococcal disease. BJOG. 2017;124(12):e280e305.Google Scholar
Kenyon, S, Brocklehurst, P, Jones, D, et al. MRC ORACLE Children Study. Long term outcomes following prescription of antibiotics to pregnant women with either spontaneous preterm labour or preterm rupture of the membranes. BMC Pregnancy Childbirth. 2008;8:1425.CrossRefGoogle ScholarPubMed
Watson, S.I., Arulampalam, W, Petrou, S, et al. The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study. BMJ Open. 2014;4(7):e004856.Google ScholarPubMed
Brown, R, Gagnon, R, Delisle, MF. Guideline No. 373.Cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can. 2019;41(2):233–47.Google ScholarPubMed
Althuisius, SM, Dekker GA, Hummel P, et al. Cervical incompetence prevention randomized cerclage trial: emergency cerclage with bed rest versus bed rest alone. Am J Obstet Gynecol. 2003;189(4):907–10.CrossRefGoogle ScholarPubMed
Stupin, JH, David M, Siedentopf J-P, et al. Emergency cerclage versus bed rest for amniotic sac prolapse before 27 gestational weeks: a retrospective, comparative study of 161 women. Eur J Obstet Gynecol Reprod Biol. 2008;139(1):32–7.CrossRefGoogle ScholarPubMed
Oh, KJ, Romero R, Park JY, et al. Evidence that antibiotic administration is effective in the treatment of a subset of patients with intra-amniotic infection/inflammation presenting with cervical insufficiency. Am J Obstet Gynecol. 2019;221(2):P140.E1–140.E18.CrossRefGoogle ScholarPubMed
Locatelli, A, Vergani P, Bellini P, et al. Amnioreduction in emergency cerclage with prolapsed membranes: comparison of two methods for reducing the membranes. Am J Perinatol. 1999;16(2):73–7.CrossRefGoogle ScholarPubMed
Schiff, E, Friedman, SA, Zolti, M, et al. A matched controlled study of Kielland’s forceps for transverse arrest of the fetal vertex. J Obstet Gynaecol. 2001;21(6):576–9.Google ScholarPubMed
Majoko, F, Gardener, G. Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births. Cochrane Database Syst Rev. 2012;10:CD005545.Google ScholarPubMed
Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. National Sentinel Caesarean Section Audit Report. London: RCOG Press; 2001 2. Information and Statistics.Google Scholar
Division, Scottish Health Statistics. Births in Scotland report 2002. Births and babies (Births 1976–2008). Scholar
Melamed, N, Segev, M, Hadar, E, Peled, Y, Wiznitzer, A, Yogev, Y. Outcome of trial of labor after cesarean section in women with past failed operative vaginal delivery. Am J Obstet Gynecol. 2013;209(1):49.e17.CrossRefGoogle ScholarPubMed
O’Mahony, F, Hofmeyr, GJ, Menon, V. Choice of instruments for assisted vaginal delivery. Cochrane Database Syst Rev. 2010;(11):CD005455.Google ScholarPubMed
Royal Australian and New Zealand College of Obstetricians and Gynaecologists. College Statement C-Obs 16: Instrumental vaginal delivery. Melbourne, Australia: RANZCOG; 2009. Scholar
Royal Australian and New Zealand College of Obstetricians and Gynaecologists. College Statement C-Obs 13: Guidelines for use of rotational forceps. Melbourne, Australia: RANZCOG; 2009, Scholar
Murphy, DJ, Liebling, RE, Patel, R, Verity, L, Swingler, R. Cohort study of operative delivery in the second stage of labour and standard of obstetric care. BJOG. 2003;110(6):610–15.CrossRefGoogle ScholarPubMed
Murphy, DJ, Liebling, RE, Verity, L, Swingler, R, Patel, R. Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study. Lancet. 2001;358(9289):1203–7.Google ScholarPubMed
McDonnell, S, Chandraharan, E. Determinants and outcomes of emergency caesarean section following failed instrumental delivery: 5-Year observational review at a tertiary referral centre in London. J Pregnancy. 2015;2015:627810.Google Scholar
Tahir, N, Chandraharan, E. Emergency caesarean sections following a failed instrumental delivery: maternal and perinatal outcomes. In Book of Abstracts. European Congress on Intrapartum Care. Stockholm, 2017.Google Scholar
Ramphul, M, Ooi, PV, Burke, G, Kennelly, MM, Said, SA, Montgomery, AA, Murphy, DJ. Instrumental delivery and ultrasound: a multicentre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery. BJOG. 2014;121(8):1029–38.CrossRefGoogle Scholar

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