Once the decision to operate has been made, the procedure should be performed immediately at the site where cardiac arrest has taken place and standard basic and advanced life support resuscitation methods should continue throughout. These should include manual displacement of the uterus towards the patient's left side, to reduce aortocaval compression. If the arrest occurs in a healthcare facility that has staff on site who are capable of performing a<unk>  (such as at a hospital), the patient should not be moved to an operating theatre as this will delay the procedure. Out-of-hospital cardiac arrests may need to be transported to a healthcare facility first if qualified staff are not immediately available. Other than a scalpel, no specialised surgical equipment is needed for a<unk> . The American Heart Association recommends that healthcare facilities that may be required to treat a case of maternal cardiac arrest should keep in stock an emergency equipment tray for the purpose, including a scalpel with a No. 10 blade, a Balfour retractor, surgical sponges, Kelly and Russian forceps, a needle driver, sutures and suture scissors - but the procedure should commence regardless of whether the tray is available. Basic aseptic measures, such as pouring antiseptic solution over the woman's abdomen prior to incision, may be considered as long as this adds no delay. An assistant should manually displace the gravid uterus to the woman's left throughout the procedure until the fetus has been delivered, to assist the simultaneous efforts of those resuscitating the woman. Either a classical midine incision or a Pfannenstiel incision may be used depending on operator preference; the former may theoretically give better exposure, but practising obstetricians or surgeons may be more comfortable with a Pfannenstiel approach as this is more commonly used for Caesarean sections. Once the uterus is opened, the fetus is delivered and should be resuscitated by a separate team. It may be possible to then use the abdominal incision to deliver direct cardiac massage through the (intact) diaphragm. After the placenta is delivered, the uterus is massaged to stimulate contraction and is closed with a running locking absorbable suture and the abdomen is then closed; alternatively, the wound may be temporarily packed with sterile gauze, with definitive closure delayed until specialist obstetric help arrives or until the patient is fit for transport to a formal operating theatre. Uterotonic agents like oxytocin may be considered, balancing potential reduction of haemorrhage with the tendency of oxytocin to cause hypotension. Antibiotics should be administered to reduce infection risk if maternal survival is thought feasible at this stage of the resuscitation. If there is return of spontaneous circulation, additional uterotonic agents will likely be needed due to bleeding from uterine atony.
Resuscitative hysterotomy
Uterine balloon tamponade
Tubal ligation
Tubal reversal
Lower segment Caesarean section
Cervical cerclage
Labor induction
Trial of labour