Resuscitative Hysterotomy - Procedure Instructions When? ASAP. Within 4 minutes when possible. Who? Pregnant patient with uterus above umbilicus. Why? To increase chance of maternal survival. 1) Cardiac Arrest Management • Call for help: ICU, 0B • Compressions, Airway, Defib early • Use hands to cup uterus up and to left • IV above diaphragm 2) Gather Supplies • Chlorhexidine, Sterile gloves & towels. • Scalpel, Scissors • Umbilical Clamps 3) Cut Abdomen • Scalpel: Midline Incision Umbilicus - Pubic symphysis • Fingers: Bluntly separate rectus muscles down middle • Scissors or Fingers: Bluntly open peritoneum 4) Cut Uterus • Scalpel: Small incision lower end of uterus • Insert Fingers, lift uterus wall away from infant • Scissors: Cut uterus to fundus 5) Deliver • Push head out, then body. Apply fundal pressure PRN. • Clamp & cut cord → NRP. • Deliver placenta. 6) Continue Maternal Care • Compressions + Consider Reversible • If ROSC: prepare to manage PPH, temporarily pack abdomen. Dr. Sarah Foohey @SarahFoohey #Resuscitative #Hysterotomy #Procedure #Instructions #checklist #obstetrics #emergency
