PODCAST: Perimortem C-section – The Resuscitative Hysterotomy

Podcast production, editing and sound design by Rajiv Thavanathan and Richard Hoang.

Blog post by Anton Helman, June, 2020.

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:

Excellent summary table of resuscitative hysterotomy by Lauren Westafer of FOAMcast

From FOAMcast Episode 60 https://foamcast.org/2016/11/25/episode-60-resuscitative-hysterotomy-first-trimester-emergencies/ (creative commons)

Sara Gray at Essentials of EM on perimortem c-section

Procedural video on perimortem c-section

Pitfall: The most common pitfall in maternal cardiac arrest is delaying the resuscitative hysterotomy. The sooner the procedure is initiated, the more likely maternal and neonatal survival.