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Prehospital resuscitative hysterotomy: a practice review
Caroline Leech1,2, Camella Main3,4, Kim Hinshaw5
1Emergency Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK caroline.leech@uhcw.nhs.uk.
Emergency Medicine Journal : EMJ
|November 13, 2025
Summary
Managing cardiac arrest in pregnant patients requires specialized approaches. This review covers prehospital resuscitative hysterotomy (RH) adaptations, indications, and procedures to improve maternal and fetal survival chances.
Area of Science:
- Emergency Medicine
- Obstetrics
- Cardiology
Background:
- Out-of-hospital cardiac arrest (OHCA) in pregnant patients presents unique clinical challenges.
- Standard resuscitation protocols may require modifications for pregnant individuals.
Purpose of the Study:
- To review adaptations in resuscitation techniques for pregnant patients.
- To outline indications, preparation, surgical procedure, and post-procedure care for prehospital resuscitative hysterotomy (RH).
Main Methods:
- Literature review of existing studies and guidelines on maternal OHCA and resuscitative hysterotomy.
- Analysis of adaptations to standard resuscitation for pregnancy.
- Exploration of the surgical aspects and care surrounding RH.
Main Results:
- Resuscitative hysterotomy (RH) is a critical intervention in specific cases of maternal OHCA.
- Prehospital teams require specific training to effectively perform RH.
- Timely intervention is crucial for maximizing maternal and fetal survival.
Conclusions:
- Prehospital clinicians should be trained in RH to enhance maternal and fetal outcomes.
- Further research is needed to define optimal timing for RH and improve the chain of survival for maternal OHCA.
- Guidelines for maternal OHCA management require further development.
