Written by Vivian Lei
Spoon Feed
Resuscitative hysterotomy for out-of-hospital cardiac arrest rarely results in maternal survival to hospital discharge (4.5%). Neonatal outcomes are better (45%), with survival possible even after extended resuscitation and with preterm gestations.
The double-edged scalpel of resuscitative hysterotomy
Given the urgent decision-making required for resuscitative hysterotomy (RH), clinicians should be aware of maternal and neonatal survival rates following RH for out-of-hospital cardiac arrest (OHCA). Existing guidelines are based primarily on data from in-hospital cardiac arrests, which ignore the challenges specific to OHCA settings, including delays in intervention, lack of skilled personnel, and limited access to obstetric expertise.
This systematic review evaluates maternal and neonatal outcomes following RH for OHCA based on an analysis of 42 publications encompassing 66 maternal and 68 neonatal cases. Key findings indicate that maternal survival to hospital discharge was only 4.5% (3/66), whereas neonatal survival was 45.0% (27/60). The longest recorded duration from maternal collapse to RH associated with neurologically intact survival was 29 minutes for mothers and 47 minutes for neonates. Neonatal survivors were documented at gestations as early as 26 weeks. Maternal survival was observed only in cases of medical (non-traumatic) cardiac arrest, particularly thromboembolic events. This study is limited by the low quality of available evidence, relying mostly on case reports and case series, leading to a high risk of bias. Additionally, inconsistent data, potential publication bias, and variability in healthcare systems hinder generalizability, emphasizing the need for prospective studies with standardized reporting.
How will this change my practice?
Maternal OHCA is rarely encountered on a typical emergency department shift, but knowing when, why, and how to perform a resuscitative hysterotomy is essential and time-sensitive. This data provides a reference to guide my decision-making and expectations of survivability for mother and baby in these challenging cases.
Another spoonful: How to do a resuscitative hysterotomy!
Source
Maternal and neonatal outcomes following resuscitative hysterotomy for out of hospital cardiac arrest: A systematic review. Resuscitation. 2025 Feb;207:110479. doi: 10.1016/j.resuscitation.2024.110479. Epub 2024 Dec 29. PMID: 39736393
