‘4-Minute Rule’ Guides Cesarean Timing

Physiologic mechanisms and team coordination inform management during maternal cardiac arrest

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Resuscitative cesarean delivery improves maternal outcomes during cardiac arrest by relieving aortocaval compression and restoring circulation.
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The procedure is indicated at 20 weeks' gestation or greater, or when the uterine fundus reaches the umbilicus.
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Immediate cesarean delivery is recommended for term patients or those pulseless upon arrival, rather than waiting for the 4-minute threshold.
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Operational factors like transport delays can negatively impact outcomes, making bedside procedures preferable.
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Evidence for the procedure is limited, primarily based on case reports and expert consensus, highlighting the need for further research.

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