Death while pregnant

[DwayneEMTP]

Does someone have a more precise definition of 'perimortem' than "at or near the time of death" That would seem to cover too much ground for a very focused study, although perhaps with such a small grouping over such a large period of time that is all you get.

The reason I ask is that this seems like an amazing figure, "In 10 years, 40 perimortem deliveries were registered, of which 25resulted in neurologically intact surviving infants (62.5%)." But not so amazing if perimortem can mean anywhere from three hours premortem (is that a word?) to slightly after clinical death.

Kind of off the subject, but I found the following paragraph, referenced from Doc's article above, kind of interesting...

"Fear of litigation may prevent intervention in what would be, by all medical judgment, appropriate circumstances for a PMCD [Perimortem Cesarean Delivery]. However, no lawsuits filed on the basis of wrongful performance of PMCD have been reported in the literature. Only one legal penalty has been levied in regard to PMCD, the death penalty, which was given in the 18th century for failure to perform the procedure."

Have a great day everyone!

Dwayne

[ERDoc]

Does someone have a more precise definition of 'perimortem' than "at or near the time of death" That would seem to cover too much ground for a very focused study, although perhaps with such a small grouping over such a large period of time that is all you get.

The reason I ask is that this seems like an amazing figure, "In 10 years, 40 perimortem deliveries were registered, of which 25resulted in neurologically intact surviving infants (62.5%)." But not so amazing if perimortem can mean anywhere from three hours premortem (is that a word?) to slightly after clinical death.

Kind of off the subject, but I found the following paragraph, referenced from Doc's article above, kind of interesting...

"Fear of litigation may prevent intervention in what would be, by all medical judgment, appropriate circumstances for a PMCD [Perimortem Cesarean Delivery]. However, no lawsuits filed on the basis of wrongful performance of PMCD have been reported in the literature. Only one legal penalty has been levied in regard to PMCD, the death penalty, which was given in the 18th century for failure to perform the procedure."

Have a great day everyone!

Dwayne

Perimortem means around the time of death. Generally it applies to the time of injury to the time of death or shortly thereafter (usually the mother is not pronounced until the fetus is out). There are not very many cases so it is hard to do a good study. It is also hard to get approval for a prospective study. Most of the info comes from retrospective chart review.

[Asysin2leads]

I'm with Dust. CPR and haul ass. There were two medics in Jersey who tried the emergency C-section, the baby died, as did their careers as paramedics. Had the baby lived, well, who knows.

[ERDoc]

I'm with Dust. CPR and haul ass. There were two medics in Jersey who tried the emergency C-section, the baby died, as did their careers as paramedics. Had the baby lived, well, who knows.

Out of curiosity, were they given orders to do the c-section? This may help with our discussion about pericardiocentesis. This could set presidence.

[medic001918]

Out of curiosity, were they given orders to do the c-section? This may help with our discussion about pericardiocentesis. This could set presidence.

While not 100% positive, I believe that they were given orders to perform the procedue. It was still found to be out of their standard protocol and more importantly out of their scope of practice. This is what led to the demise of their careers as paramedics. This is just me trying to remember information from the top of my head. If someone else could verify that information, it would be greatly appreciated.

Thanks,

Shane

NREMT-P

[Asysin2leads]

While not 100% positive, I believe that they were given orders to perform the procedue. It was still found to be out of their standard protocol and more importantly out of their scope of practice. This is what led to the demise of their careers as paramedics. This is just me trying to remember information from the top of my head. If someone else could verify that information, it would be greatly appreciated.

Thanks,

Shane

NREMT-P

According to the legends, the paramedics claimed they were given orders to do so, but the doctor later denied giving the orders. I don't know how true that is as I'm pretty sure New Jersey uses taped lines in telemetry conversations. All right, I've actually looked into this now. Apparently this occured on 09/25/1997 and involved two paramedics from Jersey City Medical Center responding to a call in North Bergen, and from the newspapers I can find, the baby actually lived. Here's a copy of the full text of the story:

N.J. Paramedics Face Inquiry Over Emergency C-Section

By DAVID W. CHEN

9/27/97 The New York Times

New Jersey health officials are investigating the actions of two paramedics

who performed an emergency Caesarean section on Thursday to deliver the baby

of a woman in North Bergen who was in cardiac arrest and could not be

revived.

The paramedics acted while consulting by radio with emergency room doctors

at Jersey City Medical Center, officials said, but state health regulations

forbid paramedics to perform surgical operations. The emergency workers said

they believed the procedure was their only hope of saving the baby.

The full-term baby girl survived but is in critical condition; the mother,

who was 37, died.

The two paramedics were placed on desk duty, with pay, pending the outcome

of the state investigation, which officials said should be completed next

week.

"This was so unusual," said Dr. Leah Ziskin, the deputy commissioner of the

state's Department of Health and Senior Services. "Our review is not

complete."

But to hospital and volunteer officials, the only thing clear was that the

two paramedics were heroes, in spite of the rules.

"These two people, a man and a woman, they've gone through probably the

most traumatic situation of their professional career, so light duty is more

than appropriate," said Bill Dauster, a spokesman for Jersey City Medical

Center. "We probably didn't need the state to tell us to do that."

The events, according to spokesmen from the Jersey City Medical Center and

the North Bergen Volunteer First Aid Squad, unfolded as follows:

At 5:30 a.m. Thursday, the North Bergen squad received a 911 call from

someone in a residential neighborhood in the uptown section of North Bergen,

saying that a woman was not breathing. Two volunteers, who were on the

midnight-to-7 a.m. shift, arrived a few minutes later, finding the woman in

cardiac arrest, with no heartbeat and no sign of breathing. They tried to

revive her, said Mary Ellen Cleveland, the president of the first aid squad.

A few minutes later, two paramedics from the staff of Jersey City Medical

Center arrived at a house in the neighborhood from their base in Weehawken.

The woman had still not been resuscitated; the baby was lodged in the birth

canal.

"They made a determination that she was dead," Dauster said. "And then they

said, 'Oh my God, we have to do this."'

In a telephone consultation with doctors at Jersey City Medical Center, the

paramedics and the doctors made a "joint decision" to try a Caesarean

section, he said. The two paramedics, both of whom were described by Dauster

as seasoned, delivered the baby just after 6 a.m.

The baby had no pulse at birth but was revived by the paramedics.

Another ambulance from West New York then came to assist, and the woman and

the baby were taken separately to Palisades Medical Center in North Bergen.

The woman was pronounced dead at the hospital. The baby was later taken to

Jersey City Medical Center.

Officials said they had not yet determined what caused the woman's heart

attack.

Friday, a woman who answered the phone at Palisades Medical Center said the

hospital had no comment on the incident. Dauster and Ms. Cleveland declined

to give the names of the family, the paramedics or the volunteer emergency

medical technicians from the North Bergen squad.

It was the first time anyone at Jersey City Medical Center could recall

such a case, Dauster said. But he added that everyone was proud of the

paramedics.

"What they did was step over what regulators have outlined for them into

the moral arena," he said. "Most people are going to view this as an act of

heroic endeavor; that's how we're viewing it."

The baby, he added, was named Davida by the nurses at Jersey City Medical

Center. She weighed about 10 pounds.

I've looked everywhere for the outcome and I can't find it, I even looked at the websheet of shame that the New Jersey State Department of Health nicely puts out naming all of the providers who had their certifications suspended or revoked, and while I found the name of a paramedic I knew while working in Jersey got his cert revoked for diluting the morphine in North Carolina, I can't find anything relating to this case. However, it doesn't look like anyone is on the sheet of shame from before 1999, so if they had their certs yanked before then, they may not show up.

ERDoc, if you are really interested in this case, I suggest you contact the EMS office in Trenton and see if they can give you the info. They usually are a friendly bunch and obviously revocation actions are public information, so they should be able to help you out. Here's there info:

NJ State EMS office

Department of Health and Senior Services

P. O. Box 360, Trenton, NJ 08625-0360

Phone: (609) 292-7837

Toll-free in NJ: 1-800-367-6543

Our Locations

Let us know if you find anything out.

[PRPGfirerescuetech]

yes...that is the story.

However, there has never been any verifyable evidence of this story, and believe me, i looked into it. I wrote a research paper on "EMS folklore" for one of my classes....

[CCMHmedic]

Don't get me wrong, but I think the medics did the right thing. Saving the life of the child was the primary objective.

[Asysin2leads]

yes...that is the story.

However, there has never been any verifyable evidence of this story, and believe me, i looked into it. I wrote a research paper on "EMS folklore" for one of my classes....

Ummmm, see newspaper article above?

[PRPGfirerescuetech]

Ummmm, see newspaper article above?

Was that there when I posted originally?

I didnt think I was that tired....