Perimortem Cesarean Delivery (PMCD) / Resuscitative Hysterotomy

Question 1

What are the most common causes of cardiac arrest in pregnancy?

Answer 1

• cardiac arrhythmia

- drug use

Question 2

When do you perform a PMCD?

Answer 2

Within five (5) minutes

Question 3

Describe how you perform a PMCD.

Answer 3

Blade cut skin, fascia, muscle with one cut then uterine incision

Question 4

If a pregnant woman develops cardiac arrest at 28 weeks gestation, describe how you will handle the situation.

Answer 4

• high quality CPR
• defibrillation when indicated
• airway management
• place IV above diaphragm
• stop magnesium and give calcium gluconate if receiving magnesium

Question 5

How do you monitor the fetus during CPR?

Answer 5

• detach fetal monitors

- prepare for perimortem c-section

Question 6

What is the four (4) or five (5) minute rule?

Answer 6

Hysterotomy by four (4) minutes, baby out by five (5) minutes if no return of spontaneous circulation

Question 7

Describe how chest compressions are performed.

Answer 7

High quality chest compressions

Question 8

When do you stop chest compressions for a patient in cardiac arrest?

Answer 8

No return of spontaneous circulation after resuscitative hysterotomy

Question 9

Do you recommend relocating the patient to an operating room for PMCD? Why or why not?

Answer 9

No. Resuscitative c-section delivery is last resort for maternal survival and should be performed without delay