Resuscitative Hysterectomy (Perimortem C-Section)

Essential Equipment

Sterile glovesScalpel bladeScissors (bandage scissors or trauma shears)Sterile towels2 clamps

Steps

Procedure is only indicated if gestational age is greater than 24 weeks (fundal height ~4 cm above umbilicus).

  1. Call for help (OB, neonatology, surgery) but do not delay to allow arrival of consultants. Ideally, the C-section should be started within 4 minutes of onset of compressions.

  2. Do not waste time preparing sterile operating field.

  3. Using a scalpel blade, make a midline vertical incision through the abdominal wall extending from the symphysis pubis to the umbilicus.

  4. Carry the incision through all abdominal layers into the peritoneal cavity.

  5. Retract the abdominal wall laterally in both directions to expose the anterior surface of the uterus.

  6. Retract the bladder inferiorly. If full, aspirate the bladder to evacuate it and permit better access to the uterus.

  7. Make a small (~5 cm) vertical incision through the lower uterine segment (lowest part of the uterus) until amniotic fluid is obtained or the uterine cavity is clearly entered.

  8. Insert the index and long fingers into the incision and use them to extend the incision vertically to the fundus until a wide exposure is obtained. You can also use bandage scissors (or trauma shears) to extend the excision.

  9. Gently deliver the infant.

  10. Clamp and cut the cord.

  11. Evaluate and resuscitate the newborn (see Newborn Resuscitation).

  12. Coordinate definitive repair/care with consulting physicians and patient’s family.