If Mom's dead in the field, go to munchkinland. Why?
The mother's dead. The child will be very hi-risk, will have poor gases, lo
apgars - if he/she makes it at all. He/she needs aggressive support
(ventilation, uac, uvc, maybe surfactant, seizure control, proper nursing
support) and wasting time at an adult hospital will only make things worse.
If munchkinland has a gyne dept and is a university center, the residents in
ped gyne (and maybe even the staff!) will be able to handle a c-section in
Push comes to shove, a pediatric surgery fellow should be able to do a
c-sect, or more properly, the first half of a c-sect. If mom's dead anyways
the the last half is unnecessary.
If push really comes to shove, eg rural situation, mom apneic, pulseless and
unresponsive after appropriate resuscitative efforts, help for mom > 1hr
away - the doctor in the field should call for neonatal help ( transport
team) stat and discuss possibility of removing the child himself or herself.
In most countries, other than our superspecialised Western ones, virtually
every physician has done cesarians as part of their internships. Look for a
pediatrician who did medical school and internship in the third world if
you're in a rural area. He/she should be able to handle both crises!
G Forbes MD
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