Resuscitative hysterotomy

Overview

Resuscitative hysterotomy (or perimortem caesarean section) as the name suggests, is a resuscitative procedure that is initiated following maternal traumatic cardiac arrest with the primary focus being maternal survival.  The aim of the procedure is to empty the uterus which ultimately alleviates both aortocaval and inferior vena cava compression, restoring blood volume and venous return to the woman. 

Widespread evidence suggests that if RH is performed between 4-5 minutes following maternal collapse there is an increased chance of both maternal and fetal survival. Given the critical timing to initiate RH, the procedure typically occurs in the emergency department following maternal trauma and requires team preparedness and knowledge of the procedural techniques to improve the chances of survival for both the mother and fetus. Considerations also need to be made around crisis resource management principles including requirements within the resuscitation team for both the woman and the fetus.

Description

This resource kit provides healthcare workers with the ability to recognise the indications and perform a resuscitative hysterotomy in a pregnant patient who has sustained significant trauma.

Learning objectives

By the end of this session the participant will be able to:

• Recognise the severely injured pregnant trauma patient
• Perform a detailed clinical assessment to identify life threats following major trauma
• Understand the indications and contraindications for resuscitative hysterotomy
• Understand the technical skill of resuscitative hysterotomy
• Understand the Crisis Resource Management (CRM) principles when managing maternal cardiac arrest.

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