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Maternal cardiac arrest — DIPIMC MCQ

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HardResuscitationMaternal cardiac arrestDIPIMCDipIMC

A woman at 34 weeks of pregnancy collapses in cardiac arrest. CPR is commenced and there is no return of spontaneous circulation after the first cycle. The uterus is palpable well above the umbilicus. Which interventions are most important in the first few minutes?

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Correct answer: B — Manually displace the uterus to the left and prepare for resuscitative hysterotomy

In maternal cardiac arrest beyond around 20 weeks, manual displacement of the uterus to the left relieves aortocaval compression while effective compressions continue, and resuscitative hysterotomy should be performed by about five minutes if there is no return of spontaneous circulation. A full lateral position makes good-quality compressions impossible, and a left tilt is less effective than manual displacement. Hysterotomy is undertaken primarily to improve maternal survival, not solely for the foetus. Pearl: preparation for hysterotomy begins immediately, not after prolonged unsuccessful resuscitation.

Reference: Resuscitation Council UK Guidelines 2025 (Special Circumstances); MBRRACE-UK