Rebellion in EM 2019: Resuscitative Hysterotomy via Jaime Hope, MD
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Background:
- Katz VL et al. Obset. Gynecol. 1986
- 188/269 survivors
- Must act fast!
- 70% of survivors within 5 minutes of intervention
ABCD’S of Resuscitative Hysterotomy
- A: Appropriate patient selection (Class I/Level A evidence)
- Pregnant at least 20 wks (uterus at level of umbilicus or higher)
- Loss of vitals and no ROSC within 4 minutes of resuscitation
- B: Big, bold, bone to bone cut
- Xiphoid process down to pubic symphysis
- C: Cut the uterus
- Use scalpel just until gush of fluid from uterus
- Put scalpel down, put finger in hole and cut the rest of the uterus with scissors
- D: Deliver the baby
- Head first if possible and be mindful of umbilical cord
- S: Stop the bleeding
- Compress and pack uterus
Do NOT waste time…
- Prepping the skin
- Obtaining consent
- Assessing fetal heart rate
- Waiting for Ob/Gyn
- Moving to OR
References:
- Katz VL et al. Perimortem Cesarean Delivery. Obstet Gynecol 1986. PMID: 3528956
Post Transcribed By: J. Yosuf Alam, MSIV
Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)
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