In the supine position, the gravid uterus begins to compromise blood flow in the IVC and abdominal aorta at approximately 20 weeks gestation; however foetal viability begins at approximately 24 weeks. So, at:

1. Gestational age < 20 weeks – Do not consider emergency delivery; a gravid uterus of this size is unlikely to compromise maternal cardiac output
2. Gestational age 20 – 23 weeks – Initiate emergency delivery to permit successful resuscitation of the mother only
3. Gestational age > 24 weeks – Initiate emergency delivery to save the life of both the mother and the infant

Perimortem caesarean section:

1. Perimortem caesarean delivery uses a midline incision from the level of the fundus to the pubic symphysis to gain exposure to the uterus with the use of retractors.
2. Blunt dissection should be performed until the peritoneum is entered.
3. A vertical incision is then made from the fundus inferiorly towards the anterior bladder reflection.
4. When the uterine cavity is first entered, middle and index finger should be inserted to lift the uterine wall away from the infant while the incision is extended preferably with scissors.
5. The infant should then be delivered through the hysterotomy and immediately handed to someone skilled in neonatal resuscitation while the cord is clamped.
6. The placenta should be removed before closure and maternal resuscitative efforts continued.