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Maternal cardiac arrest resuscitative hysterotomy — DipIMC MCQ

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HardResuscitationMaternal cardiac arrest resuscitative hysterotomyDipIMC

A 35-year-old pregnant woman at 38 weeks remains in cardiac arrest despite four minutes of high-quality CPR and manual uterine displacement. A doctor with appropriate skills is present. What is the most appropriate management?

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

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Correct answer: D — Proceed to resuscitative hysterotomy/perimortem caesarean while continuing ALS

When maternal cardiac arrest occurs in advanced pregnancy and ROSC is not achieved rapidly, resuscitative hysterotomy should be considered from around four minutes to improve maternal venous return and fetal chances. It is a maternal resuscitation procedure and should not wait for fetal monitoring or theatre-level sterility. Transfer before intervention may waste critical time. The pearl is that decisive action on scene can be lifesaving in maternal arrest.

Reference: Resuscitation Council UK Special Circumstances Guidelines 2025; JRCALC Guidelines 2025