Embryo Project Encyclopedia Articles

In 1986, Vern L. Katz, Deborah J. Dotters, and William Droegemueller published “Perimortem Cesarean Delivery,” an article in which they developed the Four Minute Rule for perimortem cesarean sections. The Four Minute Rule states that if a pregnant woman’s heart stops beating, physicians should begin an operation to deliver the fetus within four minutes and aim to have the fetus delivered within five minutes of cardiac arrest. Although cardiac arrest during pregnancy is uncommon, it can happen when pregnant women experience trauma, blood clots, infection, or have preexisting heart conditions. In the article, the authors emphasize how the Four Minute Rule increased maternal and fetal survival rates and decreased cases of severe fetal brain damage. The article “Perimortem Cesarean Delivery” was the first article to present the Four Minute Rule, which has influenced international guidelines and become the standard for maternal resuscitation and fetal survival in emergency medicine, operating rooms, and many other aspects of medical practice.

In the May 1996 edition of The Annals of Surgery, John A. Morris and his collaborators published “Infant Survival After Cesarean Section for Trauma,” in which they evaluate the use of emergency cesarean sections for the treatment of pregnant trauma patients. During a cesarean section, a physician removes a fetus from a pregnant woman through an incision in her abdomen and uterus. When a pregnant woman experiences trauma, physicians can perform an emergency cesarean section to remove the fetus and administer medical treatments that would not be possible while the woman is pregnant. In their article, Morris and his colleagues examine the fetal outcomes following emergency cesarean sections to determine when the procedure should be used in a trauma setting. The authors support the use of emergency cesarean sections in trauma patients when those patients demonstrate high degrees of maternal and fetal distress. Morris and his team’s article is one of the first to focus on how trauma affects third trimester pregnancies and to develop an algorithm to help physicians treat those patients.