Resuscitative cesarean delivery: prioritizing team preparedness for one of the most challenging obstetric emergencies

Resuscitative cesarean delivery, previously perimortem cesarean delivery, is one of the rarest, yet physically and emotionally demanding procedures in obstetrics. Maternal cardiac arrest occurs in approximately 1 in 12,000 delivery admissions, with frequent delays initiating interventions. Despite clear recommendations by the American Heart Association to begin resuscitative cesarean within 4 minutes of arrest and complete delivery within 1 to 2 minutes, real-world implementation remains challenging, particularly when resuscitation occurs outside of the operating room or in the absence of the obstetrical team. Effective resuscitation hinges upon the prompt availability and seamless coordination of multidisciplinary team members, clear communication, effective cardiopulmonary resuscitation, and timely resuscitative cesarean delivery. Here, we share a set of practical recommendations and lessons learned from institutional experience. We emphasize identification and removal of institutional barriers to timely intervention and highlight the value of preparation through low-cost, in-situ simulation. We propose a series of practical measures: creating standardized maternal cardiopulmonary resuscitation protocols and checklists, clearly defining obstetric team roles in resuscitation scenarios, reviewing technical aspects of both maternal and neonatal care, and conducting periodic multidisciplinary team-based simulations. These strategies are feasible even in resource-limited environments and aim to improve team performance and patient outcomes. Our proposed model highlights the leadership role of the obstetrician in the surgical aspects of care, while recognizing that advanced life support is better handled by specialized response teams. We advocate for enhanced collaboration with emergency medicine, neonatology, and support personnel to ensure a comprehensive and cohesive approach to patient care.