Resuscitative hysterotomy in the emergency department — procedural resuscitation station

Timed procedural resuscitation station: resuscitative hysterotomy for traumatic maternal cardiac arrest outside theatre. Tests the fundal-height indication, an immediate timed decision, operative technique without anaesthesia or transfer, management of bleeding at return of spontaneous circulation, care of both patients, medico-legal defence and family communication. Includes a minute-by-minute assessor timeline, marking domains, assessor key and fail criteria.

Prompt

At 14:32 a 28-year-old woman at an estimated 35 weeks is brought into the emergency department by ambulance after being struck by a car. She arrested in the ambulance bay at 14:34. On your arrival at 14:36 there are good-quality chest compressions, a supraglottic airway, one dose of adrenaline given, and a rhythm of pulseless electrical activity. Her abdomen is distended and the fundus is four finger-breadths above the umbilicus. You are the obstetric registrar; the emergency consultant is leading the arrest and asks you to take over the obstetric decision.

Station brief

Format. Procedural resuscitation station, 12 minutes, run against a clock. You are the obstetric registrar in a resuscitation bay. The assessor runs the timeline, plays the emergency consultant and the anaesthetist, and challenges your decisions. ^[8]^[4]

Candidate instruction. Take the obstetric decision in a traumatic maternal cardiac arrest and carry it out. Verbalise your indication, your timing, your equipment, your technique, and what you expect to happen next. You will be challenged on consent and on futility; the assessor is testing whether you hold your position with evidence. ^[5]^[9]

References9Show

[1]Katz VL, Dotters DJ, Droegemueller W Perimortem cesarean delivery Obstet Gynecol, 1986.PMID 3528956
[2]Katz V, Balderston K, DeFreest M Perimortem cesarean delivery: were our assumptions correct? Am J Obstet Gynecol, 2005.PMID 15970850
[3]Einav S, Kaufman N, Sela HY Maternal cardiac arrest and perimortem caesarean delivery: evidence or expert-based? Resuscitation, 2012.PMID 22613275
[4]Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association Circulation, 2015.PMID 26443610
[5]Chu J, Johnston TA, Geoghegan J Maternal Collapse in Pregnancy and the Puerperium: Green-top Guideline No. 56 BJOG, 2020.PMID 31845507
[6]Beckett VA, Knight M, Sharpe P The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study BJOG, 2017.PMID 28233414
[7]Leech C, Nutbeam T, Chu J, Knight M, Hinshaw K, Appleyard TL, Cowan S Maternal and neonatal outcomes following resuscitative hysterotomy for out of hospital cardiac arrest: A systematic review Resuscitation, 2025.PMID 39736393
[8]Lipman S, Cohen S, Einav S, et al. The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy Anesth Analg, 2014.PMID 24781570
[9]Rose CH, Faksh A, Traynor KD, Cabrera D, Arendt KW, Brost BC Challenging the 4- to 5-minute rule: from perimortem cesarean to resuscitative hysterotomy Am J Obstet Gynecol, 2015.PMID 26212180

Resuscitative hysterotomy in the emergency department — procedural resuscitation station

Station brief

References9Show

[1]Katz VL, Dotters DJ, Droegemueller W Perimortem cesarean delivery Obstet Gynecol, 1986.PMID 3528956
[2]Katz V, Balderston K, DeFreest M Perimortem cesarean delivery: were our assumptions correct? Am J Obstet Gynecol, 2005.PMID 15970850
[3]Einav S, Kaufman N, Sela HY Maternal cardiac arrest and perimortem caesarean delivery: evidence or expert-based? Resuscitation, 2012.PMID 22613275
[4]Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association Circulation, 2015.PMID 26443610
[5]Chu J, Johnston TA, Geoghegan J Maternal Collapse in Pregnancy and the Puerperium: Green-top Guideline No. 56 BJOG, 2020.PMID 31845507
[6]Beckett VA, Knight M, Sharpe P The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study BJOG, 2017.PMID 28233414
[7]Leech C, Nutbeam T, Chu J, Knight M, Hinshaw K, Appleyard TL, Cowan S Maternal and neonatal outcomes following resuscitative hysterotomy for out of hospital cardiac arrest: A systematic review Resuscitation, 2025.PMID 39736393
[8]Lipman S, Cohen S, Einav S, et al. The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy Anesth Analg, 2014.PMID 24781570
[9]Rose CH, Faksh A, Traynor KD, Cabrera D, Arendt KW, Brost BC Challenging the 4- to 5-minute rule: from perimortem cesarean to resuscitative hysterotomy Am J Obstet Gynecol, 2015.PMID 26212180