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Resuscitative hysterotomy
A resuscitative hysterotomy, also referred to as a perimortem Caesarean section (PMCS) or perimortem Caesarean delivery (PMCD), is a hysterotomy performed to resuscitate a woman in the middle to late pregnancy who has entered cardiac arrest. Combined with a laparotomy, the procedure results in a Caesarean section that removes the fetus, thereby abolishing the aortocaval compression caused by the pregnant uterus. This improves the mother's chances of return of spontaneous circulation, and may potentially also deliver a viable neonate. The procedure may be performed by obstetricians, emergency physicians or surgeons depending on the situation.
Resuscitative hysterotomy should be performed immediately when three conditions are met:
The third condition is met when palpation finds the top of the uterus level with the navel. This usually occurs around 20 weeks gestational age, but may be earlier if there is more than one fetus (e.g. twins or triplets).
Depending on the situation, it may or may not be possible to save the patient and it may or may not be possible to save her fetus. But for both, a resuscitative hysterotomy is the best chance of survival.
Prior to viability (approximately 24 weeks' gestation), it is not possible to save the fetus. It cannot survive outside the womb, but also cannot survive inside the womb after maternal death. In this case, there is no way to save the fetus but performing a hysterotomy can save the woman.
Conversely, if the fetus has reached the point of viability, a prompt birth via Caesarean section offers the best chance of survival. Even if there is no reasonable prospect of maternal resuscitation (for example, after a nonsurvivable injury or prolonged cardiac arrest), the procedure can still serve this purpose.
The procedure should not be performed if the uterus is not judged to be large enough to cause maternal haemodynamic changes through aortocaval compression, as there is no potential benefit to the mother and the fetus or fetuses will not be viable in such an early stage of pregnancy.
Potential structures that may be damaged during the procedure are as for Caesarean section, including the fetus itself and the maternal bowel, bladder, uterus and uterine blood vessels.
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Resuscitative hysterotomy AI simulator
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Resuscitative hysterotomy
A resuscitative hysterotomy, also referred to as a perimortem Caesarean section (PMCS) or perimortem Caesarean delivery (PMCD), is a hysterotomy performed to resuscitate a woman in the middle to late pregnancy who has entered cardiac arrest. Combined with a laparotomy, the procedure results in a Caesarean section that removes the fetus, thereby abolishing the aortocaval compression caused by the pregnant uterus. This improves the mother's chances of return of spontaneous circulation, and may potentially also deliver a viable neonate. The procedure may be performed by obstetricians, emergency physicians or surgeons depending on the situation.
Resuscitative hysterotomy should be performed immediately when three conditions are met:
The third condition is met when palpation finds the top of the uterus level with the navel. This usually occurs around 20 weeks gestational age, but may be earlier if there is more than one fetus (e.g. twins or triplets).
Depending on the situation, it may or may not be possible to save the patient and it may or may not be possible to save her fetus. But for both, a resuscitative hysterotomy is the best chance of survival.
Prior to viability (approximately 24 weeks' gestation), it is not possible to save the fetus. It cannot survive outside the womb, but also cannot survive inside the womb after maternal death. In this case, there is no way to save the fetus but performing a hysterotomy can save the woman.
Conversely, if the fetus has reached the point of viability, a prompt birth via Caesarean section offers the best chance of survival. Even if there is no reasonable prospect of maternal resuscitation (for example, after a nonsurvivable injury or prolonged cardiac arrest), the procedure can still serve this purpose.
The procedure should not be performed if the uterus is not judged to be large enough to cause maternal haemodynamic changes through aortocaval compression, as there is no potential benefit to the mother and the fetus or fetuses will not be viable in such an early stage of pregnancy.
Potential structures that may be damaged during the procedure are as for Caesarean section, including the fetus itself and the maternal bowel, bladder, uterus and uterine blood vessels.