Cardiac Arrest in Pregnancy
Objective: Displace the uterus, compress on the chest (not the belly), and move toward an obstetric-capable hospital without delaying shocks.
Why This Is Hard
The fundus is at the umbilicus and you are compressing the abdomen. AHA 2025 special circumstances: aortocaval compression kills venous return. Manual left uterine displacement during CPR. Defibrillation energy is unchanged.
- If the fundus is at/above the umbilicus (~20 weeks teaching), displace the uterus to the left during CPR.
- Pads as usual. Do not withhold shocks “because she is pregnant.”
- Early notification of an OB-capable / trauma-capable receiving team. Perimortem cesarean is not a truck procedure.
Field Rules (Education)
- AHA 2025 Part 10: high-quality CPR, left uterine displacement, standard defibrillation.
- Airway may be harder (edema, aspiration). Prepare suction and a smaller tube if that is your training — still confirm with waveform.
- Causes: hemorrhage, embolism, eclampsia, same Hs/Ts. Treat what you can on the truck.
- The fetus survives if the mother gets ROSC. Do not stall ALS for a fetal monitor you do not have.
Field Pitfalls
- No uterine displacement.
- Withholding defibrillation.
- Long scene for a fetal heart tone.
Practice
60-second drill
Partner: 32 weeks, VF arrest in the bedroom. Hand placement, uterus, and destination sentence.
Related: Trauma in pregnancy, Eclampsia.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- AHA 2025 Part 10: Special Circumstances — pregnancy arrest: LUD, standard defibrillation, high-quality CPR
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.