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



#Perimortem #Hysterotomy #Instructions #Obstetrics #Emergency #management #checklist