In a pregnant patient, when should a resuscitative cesarean delivery be considered?

• A. Immediately before any defibrillation
• B. If no ROSC after 2 rounds of BLS/ACLS
• C. Only if the fetus is viable
• D. Never

Answer: (B)

The key idea is that during a pregnancy-related cardiac arrest, you should consider a resuscitative cesarean delivery when ongoing resuscitation isn’t producing a return of spontaneous circulation after initial efforts. In this protocol, if there is no ROSC after two rounds of BLS/ACLS, delivering the fetus emergently is advised. Removing the uterus’ mass and relieving aorto-caval compression can improve maternal venous return and the effectiveness of chest compressions, increasing the chance of maternal ROSC and potentially improving fetal outcome as well.

Delaying until the fetus is deemed viable isn’t the rule here, because the priority is to optimize maternal resuscitation; viability status is not the sole determinant. It’s also not performed before a defibrillation if indicated, since life-saving defibrillation should occur without waiting for cesarean. And it isn’t never appropriate, since this intervention can be a critical step to improve outcomes when standard CPR isn’t restoring circulation.