The perimortem caesarean

Indication. Cardiac arrest in pregnancy once the uterus is large enough to impair resuscitation. ANZCOR: second half of pregnancy (over 20 weeks or uterus palpable above the umbilicus for displacement). SOGC times the incision to viable pregnancies (≥23 weeks).^[1]

Timing. SOGC rec 31: caesarean no later than 4 minutes (when possible) after maternal arrest, for maternal resuscitation and fetal salvage. ANZCOR: insufficient evidence to define a specific time interval by which delivery should begin. Jeejeebhoy 2015 is the first AHA scientific statement on maternal resuscitation (the abstract does not list a start minute). Prepare the kit at the first compression so you are not waiting on theatre or ultrasound.^[1][3]

Technique (exam convention, not a trial). Midline vertical incision umbilicus to symphysis, through to uterus, deliver, clamp the cord, empty the uterus. No anaesthesia. Stay in the resus bay. Continuous manual uterine displacement until the uterus is empty. Murphy: remove uterine/fetal monitors; standard ACLS shocks and drugs.^[5]

Rationale. Emptying the uterus relieves aortocaval compression and is maternal resuscitation (SOGC: aid with maternal resuscitation and fetal salvage; ANZCOR: mother first). Do not quote “cardiac output up 60%” — that figure was not in the fetched sources. Zelop (n=462): ROSC 73.6%, survival to discharge 40.7%; most first rhythms are PEA/asystole.^[1][4]