Perimortem Hysterotomy Instructions
Do 4 minutes into arrest if uterus above the umbilicus
1. Manage Arrest
• Compressions, Secure airway, Defib early
• Place IV above diaphragm
• Cup uterus up and left to reduce IVC/aorta compression
2. Prepare
• Call for help: OB, ICU, Peds
• Gather Supplies: Chlorhexidine, Sterile Gloves,
• Sterile Towels, Scalpel, Scissors, Umbilical Clamps
3. 4 mins in: Cut
• ABDOMEN
- Cut midline umbilicus to pubic symphysis with scalpel
- Bluntly separate rectus muscles with fingers/scissors
- Bluntly open peritoneum with fingers/scissors
• UTERUS
- Make small incision in lower uterus with scalpel
- Lift uterus wall away from infant with fingers
- Cut uterus to fundus with scissors
4. Deliver
• Push head out, then body, apply fundal pressure PRN
• Clamp & cut cord, baby to peds team for NRP
• Deliver placenta
5. Continue Maternal Care
• Compressions and consider reversible causes of arrest
• If ROSC: Resuscitate, Treat PPH, Pack abdomen
Dr. Sarah Foohey @SarahFoohey
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