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Published on: September 12, 2025
Two cases of low birth weight infant survival by prehospital emergency hysterotomy
Miretta Tommila1,2, Mikko Pystynen3, Hanna Soukka4
1Emergency Medical Services, FinnHEMS 20, University of Turku and Turku University Hospital, Savitehtaankatu 1, Turku, Finland. miretta.tommila@tyks.fi.
Background:
During maternal cardiac arrest, emergency hysterotomy (EH) is recommended after four minutes of resuscitation, if no signs of spontaneous circulation are detected. This extreme procedure is believed to be potentially beneficial for both the mother and the infant. Both maternal and neonatal survivals seem to be associated to the time delay between the cardiac arrest and the delivery and in-hospital resuscitation location. In addition to this, gestational age is an important determinant to neonatal outcome.
Case Presentation:
We report two emergency hysterotomies executed in an out-of-hospital location. The infants delivered by EH were low birth weight infants and born 20-23 min after maternal cardiac arrest. Both infants survived and had normal physical and neurological growth at the age of two years. Unfortunately, mothers in these both cases died in the field.
Conclusion:
Contrary to earlier beliefs, it is possible to perform a successful EH also in out-of-hospital setting, even with incomplete surgical skills. However, training and preparation are extremely important for achieving the highest possible readiness to treat maternal cardiac arrest situations also prehospitally.
