Yes, you can and should perform Cardiopulmonary Resuscitation (CPR) on a pregnant woman experiencing cardiac arrest. While cardiac arrest is uncommon during pregnancy, it is a life-threatening emergency requiring immediate intervention for both the mother and the fetus. Standard CPR techniques must be initiated right away, but they require specific modifications to account for the anatomical and physiological changes of pregnancy. Acting quickly and confidently with these adjustments provides the best chance for survival.
Physiological Changes Requiring Altered CPR
The effectiveness of standard CPR is significantly reduced in later-stage pregnancy due to the physical presence of the enlarged uterus. After about 20 weeks of gestation, or once the uterus is palpable above the belly button, it becomes large enough to press on major blood vessels when the woman lies flat on her back. This compression is known as aortocaval compression, affecting both the aorta and the inferior vena cava.
The pressure on the inferior vena cava, the large vein that returns deoxygenated blood to the mother’s heart, reduces the volume of blood flowing back. If the heart does not receive enough blood, chest compressions cannot effectively circulate blood to the brain or the placenta. This mechanical obstruction severely limits the success of resuscitation efforts if not addressed. Therefore, a simple change in positioning becomes a necessary modification for high-quality CPR in pregnant patients.
Performing Chest Compressions and Airway Management
The most important modification to standard CPR is managing the position of the uterus to relieve the pressure on the major blood vessels. This is achieved through Left Lateral Uterine Displacement (LLUD). While the woman must remain on a firm, flat surface for effective chest compressions, the uterus should be manually pushed away from the center of the body toward the patient’s left side.
A rescuer can achieve this by standing on the patient’s right side and using one or both hands to gently push the pregnant abdomen to the left. If multiple rescuers are present, one person should be dedicated solely to maintaining this displacement throughout the entire resuscitation effort. Some guidance also suggests placing a wedge or rolled item under the right hip to create a slight 15 to 30-degree left tilt, while ensuring the chest remains flat for compressions.
The technical specifications for chest compressions remain the same as for any adult. Compress the chest at a rate of 100 to 120 compressions per minute. The depth should be at least 2 inches (5 centimeters), allowing the chest to fully recoil after each compression. Hand placement should be in the center of the chest, on the lower half of the breastbone, just as in standard CPR.
When providing rescue breaths, follow the standard ratio of 30 compressions to 2 breaths if you are trained in full CPR. A pregnant patient has a reduced reserve of oxygen and an increased risk of aspiration, meaning vomit entering the lungs. High-quality ventilation is particularly important, and trained rescuers should focus on effective breaths that cause the chest to visibly rise. If you are not trained in rescue breaths, hands-only CPR with continuous chest compressions should be performed.
Emergency Response and Transfer of Care
As soon as cardiac arrest is recognized, emergency services must be contacted immediately. It is important to inform the dispatcher that the patient is pregnant, as this allows responding teams to mobilize specialized resources.
Once professional help arrives, the focus shifts to advanced life support, which includes the use of a defibrillator and specialized medications. Defibrillation, if indicated by the heart’s rhythm, is safe and should not be withheld from a pregnant patient. The delivery of the electrical shock will not harm the fetus.
The role of the bystander rescuer is to maintain high-quality CPR, including continuous manual uterine displacement, until Emergency Medical Services (EMS) personnel take over. Rapid transition to professional care ensures that both the mother and fetus receive the best chance for survival.