Best Case Ever 82 Perimortem C-section – The Resuscitative Hysterotomy From Emergency Medicine Cases

The big reason to perform a resuscitative hysterotomy  in cardiac arrest in pregnancy is to hopefully save the life of the mother.

In addition to the resources in this post, please see also Perimortem C-Section, Severity of Illness, and Early Warning Scores In Pregnancy from the AHA 2015 Cardiac Arrest in Pregnancy Guidelines And From Other Resources
Posted on November 1, 2015 by Tom Wade MD for a list of additional resources on perimortem C-section.

Here is the Complete List With Links To Best Case Ever Series From Emergency Medicine Cases
Posted on December 29, 2020 by Tom Wade MD

Today I reviewed Best Case Ever 82 Perimortem C-section – The Resuscitative Hysterotomy  [Link is to podcast and show notes], June, 2020, from Emergency Medicine Cases.

Here are excerpts:

Prepare two resuscitation areas: one for the mother and one for the neonate.

Call obstetrics and pediatrics/NICU for assistance early.

Prepare yourself, your team and your gear.

The indications for perimortem c-section are maternal cardiac arrest with gravid uterus above the umbilicus* or known to be >20 weeks gestational age up to 30 minutes after cardiac arrest started.

*Estimate gestational age by palpating the uterus. If the fundus is above the umbilicus, assume at least 20 weeks gestation.

ACLS modifications for maternal resuscitation in perimortem c-section

  • Chest compressions 2-3 cm higher on the sternum
  • Manually displace the uterus to the left*
  • Avoid femoral lines and obtain IV access above the diaphragm

*To help relieve pressure on the mother’s IVC/aorta the current recommendation is to have the patient lying supine and apply leftwards pressure (rather than the old recommendation to have the patient in 30 degrees left lateral decubitus) to help facilitate high quality chest compressions that may be difficult with the old 30 degree lateral decubitus recommendation:

Sara Gray at Essentials of EM on perimortem c-section

Procedural video on perimortem c-section

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