Yeah, I get cranky at stories like this one: Tracy Hermanstorfer: Christmas Miracle Mom and Baby Die, Revive
I’m thrilled for the family that they both survived this event. I hope they go on to a happy, loving, long life together. It’s hard to imagine how terrifying an experience this must have been.
What’s cheesing me off is the media/theocon wankfest about what a “mystery” it all is, and about how doctors are “stunned” that Hermanstorfer “miraculously” regained a pulse after the baby was delivered. Blah blah impossible Christmas miracle HandoftheLawd yadda yadda *snore*
The short story is, she went into cardiac arrest. No one, apparently, knows why. One site said it happened shortly after an epidural; that’s unusual as an adverse effect, but it can happen. Or perhaps she had an amniotic fluid embolus, or an unexplainable cardiac arrhythmia or something else. Whatever the cause, her heart stopped, an extremely rare event.
CPR was performed for a few minutes – four or five – without success before the medical team decided to deliver the baby by crash C section. There’s nothing strange about this; it’s standard operating procedure. After the C section, resuscitation of the mother succeeded, and she was revived.
The crash section is not just to save the baby, and that’s where the news reports go horribly wrong. It’s also where outraged bloggy diatribes from the feminist side of the fence about how they should be concentrating on saving the mother, not the baby (which I haven’t seen about this case yet, but I have seen in similar situations) get up my nose.
Because one of the bog standard fundamentals of advanced cardiac life support in late pregnancy, when the opening gambits of airway/a few breaths and compressions/a shock or two/a squirt of adrenaline don’t succeed, is EMPTY THE UTERUS. Resuscitation in complete arrest is doomed to failure most of the time, it’s true, but it’s way, way more doomed to failure in the presence of a term or near-term fetus. The uterine pressure makes it difficult to ventilate a person in arrest, because chest compliance is poor and the upward pressure means it’s hard to expand the lungs. Perhaps more importantly, the uterus sits on the large vessels and stops blood returning to the heart. Tilt or manual displacement of the uterus is standard, but this doesn’t completely solve the problem.
A few cites:
Circulation 2000;102:I-229: ECC Guidelines Part 8: Advanced Challenges in Resuscitation
If standard application of BLS and ACLS fail and there is some chance that the fetus is viable, consider immediate perimortem cesarean section. The goal is to deliver the fetus within 4 to 5 minutes after the onset of arrest. If at all possible involve obstetric and neonatal personnel.8F
Why Reduce the Size and Weight of the Uterus?
With the mother in cardiac arrest, the blood supply to the fetus rapidly becomes hypoxic and acidotic, causing adverse effects in the fetus. Return of blood to the mother’s heart, blocked by the uterus pressing against the inferior vena cava, must be restored. Consequently the key to resuscitation of the child is resuscitation of the mother. The mother cannot be resuscitated until blood flow to her right ventricle is restored.
This results in the familiar admonition to immediately begin cesarean section and remove the baby and placenta when arrest occurs in a near-term pregnant woman. That single act allows access to the infant so that newborn resuscitation can be started. Cesarean section also immediately corrects much of the abnormal physiology of the full-term mother. The critical point to remember is that you will lose both mother and infant if you cannot restore blood flow to the mother’s heart.
This is not merely a last ditch attempt to save the life of the fetus; it plays an important part in the resuscitation of the mother. Many successful resuscitations have occurred after prompt surgical intervention. The probable mechanism for the favourable outcome is that occlusion of the inferior vena cava is relieved completely by emptying the uterus, whereas it is only partially relieved by manual uterine displacement or an inclined position. Delivery also improves thoracic compliance, which will improve the efficacy of chest compressions and the ability to ventilate the lungs.?
It is now recommended that cesarean section be performed within 4-5 minutes of the arrest (3) It has been shown that the shorter the interval between the onset of maternal cardiac arrest and commencement of CPR, and the shorter the time taken to deliver the fetus once CPR commences, the more likely that the mother will survive and the fetus will be neurologically intact. Timing is the most crucial factor when performing CPR in late pregnancy. Cesarean section, performed in a patient’s room within 10 minutes after arrest, was essential in the successful resuscitation of a full term parturient and her fetus during an amniotic fluid embolism (9). In that case, because of the rapid delivery of the fetus leading to immediate restoration of maternal circulation, both patients survived neurologically intact.
You get the baby out, and you get it out fast. Saving the baby is a (rather nice) bonus; the main reason you do this is to have more than a snowflake’s chance in Perth of of saving the mother.
So no, they didn’t write the woman off as dead, decide to save the baby, and stand around twiddling their thumbs and feeling sad while the Hand of God came down from the sky and miraculously raised her from the dead. They followed standard resuscitation protocol, and it worked as designed.
Nothing miraculous about it.