In this episode of the St Emlyn’s Podcast, Iain Beardsell and Simon Carley talk with Caroline Leech at the BASICs Conference about resuscitative hysterotomy following maternal cardiac arrest.
This is a calm, evidence-led discussion of a rare, high-stakes intervention that most clinicians will encounter once, if at all — and still need to get right.
Why the term resuscitative hysterotomy has replaced perimortem caesarean section
The physiological rationale: relieving aortocaval compression to improve maternal resuscitation
What the evidence actually shows about timing, maternal survival, and neonatal outcomes
Findings from Caroline’s systematic review of out-of-hospital cardiac arrest in pregnancy
Why the “4–5 minute rule” does not reflect real-world pre-hospital care
Neonatal survival at far longer timelines than traditionally taught
Practical decision-making in pre-hospital and emergency department settings
Who should perform the procedure, and why speed matters more than seniority
Aftercare challenges: open abdomen, placenta management, bleeding (or lack of it)
Team cognitive load, role allocation, and when termination at scene is appropriate
The emotional and professional impact on clinicians and families
Maternal survival after out-of-hospital arrest is rare, but not zero
Neonatal survival is higher than often appreciated, even with prolonged timelines
Delaying purely to reach hospital or a specialist may reduce benefit
The hardest part is not the incision — it is the decision, coordination, and aftermath
Training should focus as much on judgement and communication as on technical skill
This episode is not about heroics.
It is about realism, evidence, and being prepared for one of the most confronting moments in emergency care.
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