INDICATIONMaternal cardiac arrest, gestation >20 weeks (fundus at or above the umbilicus), with no ROSC after one defibrillation or one round of trauma resuscitation — deliver to save both mother and baby. CPR never stops during the procedure.
EQUIPMENT
OB CART · DRAWER 5 — C-SECTION KIT
Scalpel, 10 blade — the only truly essential item; in hand = start when the decision is made, everything else is nice-to-have
Bandage/curved Mayo scissors
Retractors
3 cord clamps + cord scissors
Dry packs / lap sponges
Splash prep (chlorhexidine or betadine) if immediately at hand — prep never delays the incision
NEONATAL SIDE — SET UP IN PARALLEL
Infant kit + airway/monitor from a separate drawer — two patients, two teams
AFTER DELIVERY / ROSC
Oxytocin 5 units IV
0 chromic suture, large needle
Skin stapler
FIG 1 · INCISION — VERTICAL MIDLINE, UMBILICUS TO SYMPHYSIS
STEPS
Manual left uterine displacement — continuous until delivery.
Call “ED OB emergency,” activate telehealth/OB support.
Decision: no ROSC after one defibrillation or one round of trauma resuscitation → cut now. Team lead decides.
Recorder calls elapsed time every minute — target incision by 4 minutes of arrest, baby out by 5.
Splash prep with chlorhexidine or betadine — never delay the incision for it.
10 blade: vertical midline incision, above the umbilicus to the symphysis, deep to fascia.
Fingers separate the rectus muscles to expose the uterus; scissors on fascia only if needed.
Vertical uterine incision; extend with fingers or bandage scissors.
Extract the infant, note the time, hand to the neonatal team. Three cord clamps: two on the baby side, cut between them, one toward the placenta — the long segment is for a cord gas (draw within ≈60 min).
Manually remove the placenta, wipe the cavity with gauze; close the uterus with running locked 0 chromic; staple the skin fast (hemostasis, not cosmetics); continue maternal ACLS — aortocaval compression is now relieved, recheck rhythm.
CPR never stops during this procedure. This is time-critical — the fundus-at-umbilicus rule decides gestational age at the bedside; don’t wait for ultrasound.