Resuscitative hysterotomy - Revision history

Rossdonaldson1: /* External Links */

2022-08-03T20:16:21Z

External Links

← Older revision		Revision as of 20:16, 3 August 2022
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	==External Links==		==External Links==
			*https://first10em.com/cardiac-arrest-in-pregnancy-the-perimortem-cesarean-section/

	===Videos===		==Videos==
	{{#widget:YouTube\|id=IwDWv2iyAos}}		{{#widget:YouTube\|id=IwDWv2iyAos}}

Blsimpso at 20:20, 29 June 2021

2021-06-29T20:20:25Z

← Older revision		Revision as of 20:20, 29 June 2021
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	*[[Emergent delivery]]		*[[Emergent delivery]]
	*[[Fundal exam in pregnancy]]		*[[Fundal exam in pregnancy]]

			==External Links==

			===Videos===
			{{#widget:YouTube\|id=IwDWv2iyAos}}

	==References==		==References==

Elcatracho: /* Indications */

2021-02-03T19:19:27Z

Indications

← Older revision		Revision as of 19:19, 3 February 2021
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	==Indications==		==Indications==
	*[[Cardiac arrest in pregnancy\|Maternal cardiac arrest]] without ROSC within 4 minutes<ref> Lavonas EJ, Drennan IR, Gabrielli A, et al. Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S501-518.</ref>		*[[Cardiac arrest in pregnancy\|Maternal cardiac arrest]] without ROSC within 4 minutes<ref> Lavonas EJ, Drennan IR, Gabrielli A, et al. Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S501-518.</ref>
	*Estimated Gestational age >24 weeks based on fundal height estimate<ref>Datner EM, Promes SB: Resuscitation Issues in Pregnancy, in Tintinalli JE, Stapczynski JS, Ma OJ, et al (eds): Tintinalli’s Emergency Medicine, ed 7. New York, The McGraw-Hill Companies Inc., 2011, (Ch) 16:p 91-97</ref>		*Estimated Gestational age >24 weeks based on [[Fundal exam in pregnancy\|fundal height estimate]]<ref>Datner EM, Promes SB: Resuscitation Issues in Pregnancy, in Tintinalli JE, Stapczynski JS, Ma OJ, et al (eds): Tintinalli’s Emergency Medicine, ed 7. New York, The McGraw-Hill Companies Inc., 2011, (Ch) 16:p 91-97</ref>
	**Fundus reaches level of umbilicus at approximately 20 weeks and increases ~1 cm each week thereafter		**Fundus reaches level of umbilicus at approximately 20 weeks and increases ~1 cm each week thereafter
	**Fundus approaches xiphoid around 36-38 weeks		**Fundus approaches xiphoid around 36-38 weeks

Elcatracho: /* See Also */

2021-02-03T19:18:54Z

ClaireLewis: /* Procedure */

2020-10-29T17:30:44Z

Procedure

← Older revision		Revision as of 17:30, 29 October 2020
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	*Close abdominal incision using skin stapler		*Close abdominal incision using skin stapler
	*Continue maternal resuscitation		*Continue maternal resuscitation

			[[File:Resuscitative+Hysterotomy+JPEG+2.jpg\|thumb\|]]

	==Complications==		==Complications==

ClaireLewis: /* Complications */

2019-09-27T15:53:51Z

Complications

← Older revision		Revision as of 15:53, 27 September 2019
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	==Complications==		==Complications==
	*Fetal injury		*Fetal injury
	*DIC		*[[DIC]]
	*Hemorrhagic shock		*[[Hemorrhagic shock]]

	==Follow-up==		==Follow-up==

SLuckettG: /* Equipment Needed */

2019-05-12T00:16:10Z

Equipment Needed

← Older revision		Revision as of 00:16, 12 May 2019
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	**Hemostats		**Hemostats
	**Sterile gauze		**Sterile gauze
	*Suction
	*Betadine or chlorhexadine		*Betadine or chlorhexadine
	*Sterile attire		*Sterile attire
			*Skin stapler

	==Pre-Procedure==		==Pre-Procedure==

SLuckettG: /* Procedure */

2019-05-12T00:15:49Z

Procedure

← Older revision		Revision as of 00:15, 12 May 2019
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	==Procedure==		==Procedure==
	''Continue CPR throughout procedure''		''Continue CPR throughout procedure as long as it can be safely accomplished''

	*Widely cleanse ~~entire~~ abdomen ~~with betadine ("betadine bath")~~		*Widely cleanse abdomen
	*Use ~~salpel~~ to make midline ~~abdominal~~ incision ~~extending~~ from the uterine fundus to ~~the~~ pubic symphysis		*Use scalpel to make a midline incision from the uterine fundus to pubic symphysis
	*~~Sharply~~ or ~~bluntly dissect through all layers of the abdominal wall at the midline until abdominal cavity is entered~~		*Dissect into peritoneal cavity using scalpel or scissors
	*Retract the abdominal wall by pulling laterally on both sides		*Make a 2 cm incision into the uterine cavity using scalpel
	*Bladder retractor may be used to reflect the bladder inferiorly to gain better visualization of the uterus		*Insert two fingers into the uterine incision between baby's body and myometrium, and use scissors to advance the incised opening
	*Make a ~~careful vertical~~ incision ~~from~~ the uterine ~~fundus to the anterior reflection of the bladder (usually a hyper-lucent transverse line near the inferior portion of the uterus).~~
	**Alternatively, make smaller incision, insert two fingers and ~~lift uterine wall away from fetus~~, ~~then~~ use scissors to ~~extend incision~~
	**Take care when incising the ~~uterus as it can be very thin and entry can inflict lacerations on the fetus~~
	**Be sure to avoid major blood vessels (lateral)
	**If anterior placenta is encountered, sharply incise through it		**If anterior placenta is encountered, sharply incise through it
	*~~Grasp~~ infant ~~manually and deliver~~ from uterus		*Manually deliver infant from uterus, avoiding grasping the infant around the abdomen
	*~~Clamp~~ and ~~cut~~ umbilical cord ~~(two clamps, cut between)~~		**Cut and clamp the umbilical cord and pass infant to neonatal team
	*Hand infant ~~off (ideally~~ to ~~Peds or NICU~~ team)		*Deliver the placenta by gentle traction
	*~~Placental removal -- Do not yank hard on cord as this can invert~~ the ~~uterus. Gentle~~ traction ~~on the cord or around the edge of the placental border should remove the organ~~		*Pack uterus with sterile gauze
	*~~Closure~~		*Close abdominal incision using skin stapler
	**Depends on maternal response to resus		*Continue maternal resuscitation
	**Should occur in the OR
	*Continue resuscitation ~~of mother~~

	==Complications==		==Complications==

SLuckettG: /* Pre-Procedure */

2019-05-12T00:11:05Z

Pre-Procedure

← Older revision		Revision as of 00:11, 12 May 2019
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	==Pre-Procedure==		==Pre-Procedure==
			*Call for help
			**Anesthesia
			**Respiratory therapist
			**NICU or pediatrics
			**Obstetrics
			**General surgery
	*Secure airway		*Secure airway
	*IV access ~~(bilateral large-bore)~~		*Establish IV access
	*Cardiac monitor		*Cardiac monitor
	*Place foley (↓ risk of ~~incising~~ bladder)		*Place foley catheter to drain bladder and decrease risk of bladder injury
			*Prepare isolette, blankets, and other appropriate equipment for neonate
	''~~None of these steps should~~ delay ~~procedure~~ beyond 5 minutes ~~after~~ maternal arrest.''		*Divide team into maternal team and neonate team
			*Call for blood products
			''Do not delay beyond 4 minutes of maternal arrest even if the above preparations have not been achieved''

	==Procedure==		==Procedure==

SLuckettG: /* Equipment Needed */

2019-05-12T00:07:44Z

Equipment Needed

← Older revision		Revision as of 00:07, 12 May 2019
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	==Equipment Needed==		==Equipment Needed==
	*C-Section or abdominal ~~ex-lap~~ kit ~~(often not~~ available ~~in ED, but may be obtained from OR if time allows)~~		*C-Section or abdominal exploratory laparotomy kit ideal if available
	**Alternatively, emergency thoracotomy kit ~~(available in most EDs)~~ has many of the needed supplies		*Emergency thoracotomy kit has many of the needed supplies
	*If surgical kit unavailable:		*If surgical kit unavailable:
	**Scalpel		**Scalpel
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	**Sterile gauze		**Sterile gauze
	*Suction		*Suction
	*Betadine		*Betadine or chlorhexadine
	*Sterile ~~garb (gown, gloves, mask)~~		*Sterile attire

	==Pre-Procedure==		==Pre-Procedure==

← Older revision		Revision as of 19:18, 3 February 2021
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	*[[Trauma in pregnancy]]		*[[Trauma in pregnancy]]
	*[[Emergent delivery]]		*[[Emergent delivery]]
			*[[Fundal exam in pregnancy]]

	==References==		==References==