Even so, as emphasized by Clark (1997) and Rose (2015) and their coworkers, and in our experiences, these goals rarely can be met in actual practice. For example, most cases of cardiac arrest occur in uncontrolled circumstances, and thus, the time to CPR initiation alone would require the irst 5 minutes. hus "crash" cesarean delivery would supersede resuscitative eforts, would necessarily be done without appropriate anesthesia or surgical equipment, and more likely than not, would lead to maternal death. Moreover, the distinction between a peri mortem versus postmortem cesarean operation is imperative (Katz, 2012; Rose, 2015). Last, in the balance, any choice may favor survival of the mother over the fetus, or vice versa, and thus there are immediate unresolvable ethical concerns. Katz (2012) has provided a scholarly review of peri mortem cesarean delivery.
Occasionally, a pregnant woman with a supposedly healthy intact fetus will be kept on somatic support to await fetal viability or maturity. This is discussed in Chapter 60 (p. 1168).
According to their review, Brown and coworkers (2013b) reported that clinically significant envenomations in pregnant women are from snakes, spiders, scorpions, jellyish, and hymenoptera such as bees, wasps, hornets, and ants. Adverse outcomes are related to maternal efects. These investigators conclude that limited evidence supports the use of a venomspeciic approach that includes symptomatic care, antivenom administration when appropriate, anaphylaxis treatment, and fetal assessment. One management scheme for North American snakebites was provided by Lei and associates (2015).
Akhtar MA, Mulawkar PM, Kulkani HR: Burns in pregnancy: efect on maternal and fetal outcomes. Buns 20:351,t1994 Albright CM, Has P, Rouse OJ, et al: Intenal validation of the sepsis in obstetric score to identiY risk of morbidity from sepsis in pregnancy. Obstet Gynecolt130:74 ,2017 Almog G, Liebergall M, Tsafrir A, et al: Management of pelvic fractures during pregnancy. Am J Orthop 36:E153, 2007 American Academy ofPediarrics, American College of Obstetricians and Gyne cologists: Guidelines for Perinatal Care, 8th ed. Elk Grove Village, 2017 American College of Critical Care Medicine and the Society of Critical Care
Medicine: Guidelines on admission and discharge for adult intermediate care units. Crit Care Med 26:607, 1998 American College of Obstetricians and Gynecologists: Intimate partner vio lence. Committee Opinion No. 518, February 2012
American College of Obstetricians and Gynecologists: Hypertension in pregnancy: report of the American College of Obstetricians and Gynecologists' task force on hypertension in pregnancy. Executive summary. Obstet Gynecol 122:1122, 2013
American College of Obstetricians and Gynecologists: Sexual assault. Committee Opinion No. 592, April 2014, Reairmed 2016
American College of Obstetricians and Gynecologists: Access to emergency contraception. Committee Opinion No. 707, ] uly 2017 a
American College of Obstetricians and Gynecologists: Critical care in pregnancy. Practice Bulletin No. 170, October 2016, Reairmed 2017b
Amy BW, McManus F, Goodwin CW, et al: Thermal injury in the pregnant patient. Surg Gynecol Obstet 161:209, 1985