Maternal Cardiac Arrest — FRCA Final MCQ

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HardObstetric AnaesthesiaMaternal Cardiac ArrestFRCA Final

A 39-year-old woman at 28 weeks' gestation develops pulseless electrical activity during emergency appendicectomy under general anaesthesia. High-quality CPR is commenced with manual left uterine displacement, and the team prepares immediately for resuscitative hysterotomy. If return of spontaneous circulation does not occur, at what elapsed time from cardiac arrest should the skin incision for resuscitative hysterotomy be started?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — 4 minutes

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as D · D = shown as E

B is correct. At 28 weeks, the gravid uterus is sufficiently large for aortocaval compression to impair venous return and the effectiveness of chest compressions. Preparation for resuscitative hysterotomy should begin immediately, but if correctly performed resuscitation has not produced ROSC by 4 minutes, the incision should be started, aiming to achieve delivery by 5 minutes. Uterine evacuation relieves aortocaval compression, increases venous return and cardiac output during CPR, and reduces maternal oxygen demand; it is primarily a maternal resuscitative intervention. Immediate incision is not the standard threshold, although immediate preparation is required. Five minutes is the delivery target rather than the time to begin. Two minutes is premature, whereas waiting 10 minutes causes harmful delay.

Reference: European Society of Cardiology. 2025 ESC Guidelines for the management of cardiovascular disease and pregnancy, section 12.4.4 and Recommendation Table 16. 2025. https://www.northwestchdnetwork.nhs.uk/wp-content/uploads/2025/12/ESC-Guidelines-for-the-management-of-CVD-in-Pregnancy-2025.pdf