The perimortem cesarean section, or better named the resuscitative hysterotomy, is a procedure that is performed at or near death of a pregnant patient. Most experts agree that this procedure should be performed in a maternal arrest with a pregnancy ≥24 weeks of gestation. Although there is no real data regarding the optimal time to delivery post-arrest, survival drastically decreases when the time from maternal death to delivery reaches 5 minutes (ie. Therefore a 4 minute rule has become standard). In this talk from Rebellion in EM 2019, Dr. Jaime Hope, MD walks us through the steps of performing this stressful procedure.
Rebellion in EM 2019: Resuscitative Hysterotomy via Jaime Hope, MD
[embedyt] https://www.youtube.com/watch?v=KC_P6h_xoOY[/embedyt]
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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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