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Lesson

The Airway in Pregnancy

11 min Airway & Breathing Skip to quiz

Objective: Position a pregnant patient so you can bag, have suction ready, and move the uterus to the left after about 20 weeks. Do not use cricoid pressure as a habit.

Why this matters

Late pregnancy changes the airway you think you know. The air left in the lungs after a normal breath is smaller, oxygen use is higher, and the stomach empties more slowly. A long look without oxygen becomes a low sat quickly. After about 20 weeks, the uterus can compress the inferior vena cava when the patient is flat.

Airway, oxygen, and moving the uterus are how you protect both patients. This is not a separate drug list. Your protocol owns induction drugs and tube size. This page does not publish either.

Verbalize
  • I line the ear up with the sternal notch, then I give oxygen. I expect the sat to fall faster than I am used to.
  • After about 20 weeks, the uterus goes to the patient’s left. Someone’s hands stay there, including during compressions.
  • Suction is on. I am not taking a long look. I am not using cricoid pressure as a habit.

Clinical sequence

  1. Estimate gestational age from the history and the fundus. Around 20 weeks, the uterus is near the umbilicus. That is when vena cava compression matters.
  2. Position the airway first. Line the ear up with the sternal notch. You may need to ramp the back. Use ear-to-sternal-notch positioning.
  3. Move the uterus to the left if the pregnancy is about 20 weeks or later. If you are doing cardiopulmonary resuscitation (CPR), keep that displacement going during compressions. Manual displacement works with compressions. See cardiac arrest in pregnancy.
  4. Give oxygen early if the sat is falling or the work of breathing is high. Swelling and weight gain can make the face and tongue larger than the patient’s baseline. Say that out loud before the first attempt.
  5. If an advanced airway is in your plan, set out suction and a backup airway first. Stop a failing look and bag. Do not add cricoid pressure as protection against aspiration.

Teaching points

  • The 2025 special-circumstances guidance treats pregnancy arrest with the same high-quality resuscitation, plus left uterine displacement and preparation for a difficult airway. The shock dose is not reduced.
  • Aspiration risk is higher because the stomach empties more slowly. Suction is the protection. Routine cricoid pressure is not the plan.

Common errors

  • Leaving a late-pregnancy patient flat on her back for a long assessment.
  • Taking a long look without giving oxygen again.
  • Treating cricoid pressure as required protection against aspiration.

Practice

One-minute check

A patient at about 32 weeks is unconscious and breathing slowly. Assign one person to the uterus, one to the airway position, and say what you will not do with cricoid pressure.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. After about 20 weeks of pregnancy, a patient who is supine needs:
2. Compared with a nonpregnant adult, oxygen reserve in late pregnancy is:
3. The airway plan in pregnancy starts with:
4. This lesson’s drug and tube-size guidance is:
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