Prehospital resuscitative hysterotomy

My colleagues and I describe a tragic case in this month’s European Journal of Emergency Medicine1. Our physican-paramedic team was called to the home of a collapsed 38-week pregnant female who was in asystolic cardiac arrest. A peri-mortem caesarean delivery was performed by the physician in the patient’s home and the delivered newborn required intubation and chest compressions for bradycardia before resuming good colour and heart rate. Sadly there was ultimately a fatal outcome for both patients, but this case reminds us of the indications for this intervention and for emergency and pre-hospital physicians to be prepared to do it. A literature search yielded only one other reported prehospital case in recent medical literature2.

1.Prehospital resuscitative hysterotomy
Eur J Emerg Med. 2011 Aug;18(4):241-2
2.Out-of-hospital perimortem cesarean section
Prehosp Emerg Care. 1998 Jul-Sep;2(3):206-8

One thought on “Prehospital resuscitative hysterotomy”

  1. thanks Cliff
    I read the paper and its a nice overview of the topic. I love hearing the accounts of anaesthetists performing emergency surgery as you almost never hear the accounts of surgeons performing emergency anaesthesia!
    I did wonder about the Pfannestiel incision choice but it is perfectly logical explanation in your paper.
    I agree with you that working in varying conditions of prehospital cases, we should all be prepared to do some emergency cutting. Take surgical airway..if we are prepared to make a hole into the trachea/cricothyroid membrane…or indeed thoracostomy..then making larger holes into the uterus or abdomen or limbs or head should not be so daunting…when the chips are down and you are a long way from anywhere.

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