Part 10.8: Cardiac Arrest Associated With Pregnancy

During attempted resuscitation of a pregnant woman, providers have two potential patients, the mother and the fetus. The best hope of fetal survival is maternal survival. For the critically ill patient who is pregnant, rescuers must provide appropriate resuscitation, with consideration of the physiologic changes due to pregnancy.To treat the critically ill pregnant patient: Modifications of Basic Life SupportSeveral modifications to standard BLS approaches are appropriate for the pregnant woman in cardiac arrest (Table). At a gestational age of 20 weeks and beyond, the pregnant uterus can press against the inferior vena cava and the aorta, impeding venous return and cardiac output. Uterine obstruction of venous return can produce prearrest hypotension or shock and in the critically ill patient may precipitate arrest.1,2 In cardiac arrest the compromise in venous return and cardiac output by the gravid uterus limits the effectiveness of chest compressions. The gravid uterus may be shifted away from the inferior vena cava and the aorta by placing the patient 15° to 30° back from the left lateral position (Class IIa) or by pulling the gravid uterus to the side.3 This may be accomplished manually or by placement of a rolled blanket or other object under the right hip and lumbar area. Other modifications are discussed below. View this table:Primary and Secondary ABCD Surveys: Modifications for Pregnant Women