Resuscitative Hysterotomy: Sara Gray

Sara Gray presents an incredible case highlighting the importance of resuscitative hysterotomy. The story is full of drama, moments that went well and moments that went poorly. It demonstrates the key points when considering this emergency lifesaving procedure. The case is a woman who is eight months pregnant and has an out of hospital cardiac arrest. The call comes in advising of an imminent arrival. This is where the preparation for a perinatal resuscitation and resuscitative hysterotomy begins. The first thing to consider is a Code OB – a maternal cardiac arrest code. This will bring neonatal doctors, obstetricians, specialist nurses, airway specialists and all the specific equipment required to the department. A Code OB can be a life saver – if you do not have this, Sara implores you to implement it. Next, you must consider which room will be used for the resuscitation. The room should have two beds and lots of space. As you are organising this, mental preparation should begin. The uncommon and serious nature of a resuscitative hysterotomy makes it a highly stressful situation. This leads to hesitation. Moreover, mental preparation in this situation is tremendously valuable. This is because it makes hesitation less likely, and appropriate action more likely. That appropriate action is the resuscitative hysterotomy which is lifesaving for three reasons. Firstly, it relieves aorto-caval compression allowing better venous return for the mother. Secondly, it improves pulmonary mechanics by allowing free and unobstructed movement of the diaphragm. Lastly, it reduces maternal oxygen demand once the baby and placenta are delivered. This leads to a maternal survival benefit of 32% and a neonatal survival benefit of 50%. Furthermore, in relation to timing, the well promoted 4-minute rule is a myth. Recent data shows maternal survival out to 15 minutes and neonatal survival out to 30 minutes. Mean time for resuscitative hysterotomy is 16 minutes. This does not mean that time is not of the essence, it absolutely is. However, it does mean that 4 minutes is not the cut-off. The aim should be to do it as soon as possible. The procedure itself is not complicated, aside from the fact that a resuscitation is still ongoing concurrently. Sara talks you through the procedure and the required equipment. This talk is a dramatic and fascinating 101 on the resuscitative hysterotomy. Sara wants to let you know – you can do this!

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