Resuscitative Hysterotomy (Dr. Rao)
Performed in a pregnant patient of > 20 weeks gestation in cardiac arrest to improve the chances of ROSC
While the procedure should be performed as quickly as possible to improve outcomes, there is generally no contraindication to performing the procedure beyond the 5 minute mark.
The procedure has benefited pregnant patients up to 15 minutes and fetuses up to 30 minutes after maternal cardiac arrest.
Start chest compressions immediately, establish an airway, and get IV access
Give blood in the setting of trauma
DO NOT stop to evaluate for fetal cardiac activity or tocometry
No need for a sterile field (but be as clean as possible)
DO NOT wait for OB/GYN to arrive before starting the procedure
With a scalpel, make a vertical incision from the xiphoid process down to the pubic symphysis, cutting through the skin, fat, fascia, and peritoneum
Avoid cutting the bladder — find it, and retract it
Blunt dissect down to the uterus
Make a vertical incision in the uterus large enough to fit 2 fingers in
Once inside, lift the uterine wall with your fingers
Use blunt scissors to divide the uterus between your fingers and extend the incision
Deliver the fetus
Double clamp the umbilical cord and cut BETWEEN the clamps
Deliver the placenta
Wipe the endometrial cavity clean with a clean, moist lap pad
Pack the uterine cavity with sterile towels
Continue resuscitation
