EMERGENCY DEPARTMENT · WALL POSTER
Resuscitative Hysterotomy
DECIDEGestation >20 weeks = If FUNDUS above UMBILICUS → PROCEED
STEPS · ◆ KEY STEP — LOGGED WITH ITS TIME
1 · IMMEDIATE (WITH CPR)
- “Maternal arrest — resuscitative hysterotomy now.” Fundus at or above the umbilicus, not reversible.
- Manual left uterine displacement — continuous until delivery.
- Call “ED OB emergency.” Activate telehealth.
- Set up for the infant: bottom drawer of the cart, airway and monitor from the top. Activate the neonatal chemical heat pad now.
- No ROSC after one defibrillation or one round of trauma resuscitation → cut now.
2 · THE INCISION
- Splash prep with chlorhexidine or betadine — never delay the incision for it.
- Incise vertical midline, above the umbilicus to the symphysis, deep to fascia.
- Fingers separate the rectus muscles to expose the uterus; scissors on fascia only if needed.
- Vertical uterine incision; extend with fingers or bandage scissors.
3 · DELIVERY & MATERNAL CARE
- Extract the infant, note the time, hand to the neonatal team. ◆ BABY OUT
- Three cord clamps: two on the baby side, cut between; one toward the placenta.
- Manually remove the placenta, wipe the cavity with gauze.
- Close the uterus with running locked 0 chromic; staple the skin.
- Continue maternal ACLS. Recheck rhythm.
EQUIPMENT
- Scalpel, 10 blade is the only essential item
- : bandage/curved Mayo scissors, retractors, 3 cord clamps + cord scissors, dry packs/lap sponges.
- Splash prep (chlorhexidine or betadine) if immediately at hand — prep never delays the incision.
- For after delivery/ROSC: oxytocin 5 units IV, 0 chromic on a large needle, skin stapler.