# Medical question - Caesarian birth.  Any doctors in the house?



## C.M. Aaron (Apr 28, 2011)

If a woman in the final days of a pregnancy was simultaneously in the final hours of a terminal disease, could doctors be standing by ready to perform an emergency Caesarian and save the baby as soon as the mother died?  I'd imagine, if one did not have to worry about saving the mother, that a Caesarian could be performed in under a minute.  Am I right in assuming that the only threat to the baby from a dead mother is the lack of oxygen coming through the umbilical cord?  The baby could live for a minute or two inside its dead mother?


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## TheFuhrer02 (Apr 28, 2011)

What kind of terminal disease? If its cancer, then I doubt the baby is still alive, considering its the mother's last hours so that around stage 4? The baby'll be, for a lack of a better phrase (pardon the lack of emotion, if it sounds like it), long dead by then, or as good as dead, with the long list of defects and complications. Basically, it depends on the disease. (Cancer, Syphilis, organ failures and the like don't exactly guarantee a live baby inside the womb... so, erm... why bother with the CS, right?)

However, doctors will most likely preempt this scenario and try to get the baby beforehand, like as early as 20-22 weeks. The fetus can already breathe independently by then (with help from a respirator), and be placed in an incubator. A CS won't be necessary if the mother has strength to deliver the baby, though it'll surely be advised very, very strongly.


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## C.M. Aaron (Apr 28, 2011)

Actually, its historical, so substitute midwife for doctor in the above scenario.  The disease is bubonic or pneumonic plague.  I know there is a lot of internal bleeding with plague.  I don't know about organ failure.


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## TheFuhrer02 (Apr 28, 2011)

Huh... Don't know much about history... But there won't be any chance that I can see in saving the baby. I mean, they can try, but the bubonic plague? Its a systemic infection. Not even the placental barrier can withstand that. Enter cell death, and I don't see the baby surviving this for 9 months in utero.

But of course, the midwife doesn't know that much, without the help of scans and advanced tech, right? Enter in a scenario where the mothers pleads the midwife (who braves it to do this operation despite his/her very contagious patient) then yeah, I guess they'd try to get the baby out.

But with the plague, and with the mother already having the disease for a long time (thus terminal stage, right?) I'm fairly certain the baby won't survive.


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## C.M. Aaron (Apr 28, 2011)

The mother would not be sick very long.  Plague kills within four days of infection, sometimes less.  What did you mean by systemic infection?  My research suggests that plague is a really, really bad case of pneumonia, but I don't know enough about pneumonia to know how it kills.  Wikipedia says that plague can bring on shock, but that does not help me either.  How does shock kill?  Does plague cause multiple system failure over the course of a couple of days or all at once at the end?


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## TheFuhrer02 (Apr 28, 2011)

Ooops, got carried away with the jargon. I do apologize.

Shock is multiple system failure, basically caused by the lack of fluids in the circulation.

Here's how the plague works: bacteria enters the body, right? The body's defense fights but loses the battle. Systemic infection means the infection quickly goes throughout the whole body, heart, lungs, kidney, lymphatics, you name it. The shock Wikipedia is referring to is the bacterial or septic one. The blood cells in the, erm, blood, become infected with the microorganism in question. The cells' capability to deliver oxygen becomes impaired. The blood itself becomes faulty, too, since the bacteria has already proliferated in it, and the ions and minerals in the blood are now pretty much useless. The victim is left dehydrated (blood in the circulation is faulty, and the oxygen they deliver is lacking or inefficient), despite having fluids in the vessels.

Over time, the lack of blood (or rather, the oxygen and other important stuff they deliver) shuts down the organ systems. Death in weeks, or days, heck, even hours.

So, to specifically answer your question... 



> Does plague cause multiple system failure over the course of a couple of days or all at once at the end?



Shock begins, I guess, a good 12-to-24-hours after the onset of the disease. Shock without treatment can last a week? 5 days? Maybe just three days. Multiple system failure happens one by one. First the kidneys, then liver and spleen, then heart and lungs, then brain. Not exactly the order every time, but this is the usual route.

Oh, and when I said "and with the mother already having the disease for a long time (thus terminal stage, right?) I'm fairly certain the baby won't survive." I meant that the disease has already gone a week or so. That's already a long time for the plague, and most likely, it has already spread to the fetus, and the fetus, being immunocompromised, will... er, die faster.


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## C.M. Aaron (Apr 29, 2011)

Thanks.  I guess I will have her deliver the baby, then catch the plague a week or so later.  Slightly less interesting story, but I'm a stickler for detail.  C.M.


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## sadiemaddie (Apr 30, 2011)

A baby can live inside a dead mother for three minutes. It has been performed on many mother's through history and even in modern times. When there is a healthy baby sitting inside a mother who is dying or is dead the doctor will save the baby before they save the mother.


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## heartofthedragon (Apr 30, 2011)

Just to clarify something, not to take away from anything Fuhrer has said, but Yersinia pestis (the bacteria that causes plague) cannot cross the placenta, even in overwhelming infection. Pneumonic plague kills due to respiratory failure and shock (of the septic kind, as mentioned above). However, it's not _exactly_ as Fuhrer has it laid out. Again, I'm just trying to clear things up so nobody gets confused.

The bacteria gets into the bloodstream because of overwhelming infection. It does nothing to the blood cells themselves. Few things actually infect blood cells in particular. But by the presence of the bacteria there, the white blood cells (the policemen of the blood) release a bunch of chemicals that cascade down a series of sequences I was never bothered to learn properly, eventually leading to a systemic inflammatory response. All the blood vessels become larger and their walls start leaking lymphatic fluid out into the tissues. This leads to a decreased blood pressure, which means that blood won't get to the major organs. That includes the placenta. Poor baby needs its placenta to live. Poor mommy needs her kidneys, liver, and so on.

I say it can be done. When she starts to get septic, the midwife starts watching her a little more closely. She deteriorates pretty rapidly (septic shock does that to you) and the midwife decides to make the decision to save the baby since mommy is pretty much a goner. The baby might have been suffering for a few days in there and has a high chance of hypoxic (low oxygen) brain injury, but I'll bet on the little guy surviving.

As for the post immediately above mine, the reason they get the baby out first in a dying mother is not necessarily because they want to save the baby. In any emergency situation involving a pregnant woman, the mother gets first priority. Why they deliver the baby is that there's no longer an extra person taking vital oxygen and nutrients away preferentially as well as they can be more drastic in what they have to do to save the mother without having to think about the effects on the baby. It makes sense, I mean you don't want to pump a pregnant woman full of adrenaline because it would negatively affect the baby. And CPR with a pregnant uterus in the way is just...awkward.


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## C.M. Aaron (May 1, 2011)

Thanks for that, heartofthedragon.


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## TheFuhrer02 (May 1, 2011)

@ HotD: Pestis can't cross the placenta? Always thought it can, like the other viruses. Cool. Learned something new today. X\'D

I'm just a med student, and I guess I still have more to learn, huh? /facepalm


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## heartofthedragon (May 1, 2011)

Pestis is one of the enterobacters, like E. coli. It's not a virus. Viruses easily cross the placenta, as you know. It's harder for bacteria to do that.

Don't worry about it. I have more to learn too.


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