IDEA Series: Building a High Fidelity Biosimulation Task Trainer for Resuscitative Hysterotomy

The Problem

idea series teaching residents quality improvementThe peri-mortem cesarean section, rebranded in recent years as the “Resuscitative Hysterotomy”, is a potentially lifesaving procedure for both a pregnant mother and her child. It is both daunting and infrequently performed, necessitating frequent review of indications, techniques, and pitfalls to ensure the best possible outcome for mother and baby. The decision to perform this procedure should be made only in pulseless women with a uterine fundus above the umbilicus, which indicates a gestation of >20 weeks.1,2 Prior studies suggest the procedure should be performed within 5 minutes of maternal cardiac arrest in order to maximize the probability of favorable maternal neurologic outcome and the secondary goal of fetal survival.3 Given the paucity of clinical exposure to this potentially-life saving intervention, resuscitative hysterotomy is an ideal candidate for simulation-mediated deliberate practice.