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Lesson

Cardiac Arrest in Pregnancy

10 min Cardiac & ECG Skip to quiz

Objective: Run cardiac arrest in pregnancy with the same advanced life support you use for other adults. After about 20 weeks, push the uterus to the left. Use the same shocks. Notify an obstetrics-capable team early.

Why this matters

Start the same arrest care you use for other adults. Keep chest compressions on the sternum. Do not move your hands onto the abdomen. After about 20 weeks, when the top of the uterus is at the umbilicus, the uterus can press on the aorta and the vena cava. That drops blood returning to the heart. During CPR, push the uterus to the patient's left with a hand. Do not withhold a shock because she is pregnant. The shock energy does not change.

Key points
  • If the top of the uterus is at or above the umbilicus, about 20 weeks, push the uterus to the left during CPR.
  • Place the pads as usual. Do not withhold shocks because she is pregnant.
  • Notify an obstetrics-capable (OB) or trauma-capable team early. Emergency cesarean delivery during arrest is not a procedure you perform in the field.

Clinical sequence

  1. If the top of the uterus is at or above the umbilicus, about 20 weeks, push the uterus to the left during CPR.
  2. Put the pads on as usual. Do not withhold shocks because she is pregnant. The energy does not change.
  3. Run high-quality CPR and the rest of advanced life support. Prepare suction. The airway may be harder.
  4. Notify an obstetrics-capable or trauma-capable team early. Emergency cesarean delivery during arrest is not a procedure you perform in the field.

Teaching points

  • Do these together: high-quality CPR, left uterine displacement, and the same defibrillation you use for other arrests.
  • The airway may be harder because of swelling or aspiration. Prepare suction. Use a smaller tube if that is your training. Still confirm the tube with waveform capnography.
  • Look for a cause you can treat: bleeding, embolism, eclampsia, and the same reversible causes as other arrests.
  • The fetus does better if the mother gets ROSC (return of spontaneous circulation, pulses back). Do not delay advanced life support for a fetal monitor you do not have.

Common errors

  • Forgetting to push the uterus to the left.
  • Withholding a shock because she is pregnant.
  • Staying on scene to listen for a fetal heart tone.

Practice

One-minute check

Partner: 32 weeks, VF arrest at home. Say where your hands go, what you do with the uterus, and which hospital you are calling.

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.

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. Fundus at the umbilicus in arrest — what do you do with the uterus?
2. Defibrillation in pregnancy:
3. Perimortem cesarean (emergency delivery in arrest) is:
4. The best chance for the fetus is:
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