Cardiopulmonary resuscitation (CPR) is a life-saving emergency procedure performed when the heart stops beating, maintaining blood flow to the brain and other organs until medical help arrives. While rare, cardiac arrest can occur during pregnancy, making immediate intervention crucial for both the mother and the unborn baby. Due to physiological changes in pregnancy, specific modifications to standard CPR techniques are necessary.
Identifying the Need for CPR
If a pregnant woman suddenly collapses, appears unresponsive, and is not breathing normally or is only gasping, she may be in cardiac arrest. To assess responsiveness, gently tap her shoulder and shout loudly. Immediately after confirming unresponsiveness and abnormal breathing, call for emergency medical services without delay. If others are present, delegate someone to make the call while you prepare to start CPR.
If you are unsure whether a pulse is present or if it takes more than a few seconds to find, begin chest compressions without delay. Early initiation of compressions is more beneficial than delaying action to confirm a pulse, ensuring valuable time is not lost for both the mother and baby.
Performing CPR on a Pregnant Woman
Performing CPR on a pregnant woman requires specific modifications due to the unique physiological changes that occur during pregnancy, primarily due to the enlarging uterus. The woman should be placed on her back on a firm, flat surface for effective chest compressions.
A significant modification addresses aortocaval compression, where the enlarged uterus presses on major blood vessels (aorta and vena cava), reducing blood flow to the heart. This compression can significantly compromise circulation for both mother and fetus, especially after 20 weeks of gestation. To alleviate this, perform left lateral uterine displacement (LLUD) continuously during CPR. This involves manually pushing the woman’s abdomen to her left side using one or two hands, shifting the uterus off the vessels. Alternatively, if possible, place a small wedge or pillow under her right hip to create a 15-30 degree left lateral tilt, while ensuring her chest remains flat on the surface for compressions.
Chest compressions should be performed in the center of the chest, on the lower half of the breastbone, similar to non-pregnant individuals. The rate should be 100 to 120 compressions per minute, with a depth of 2 to 2.4 inches (5-6 cm). It is important to allow the chest to fully recoil after each compression to ensure adequate blood flow. Maintain high-quality, uninterrupted compressions for effective resuscitation.
After every 30 chest compressions, deliver two rescue breaths. To open the airway, use the head-tilt/chin-lift maneuver, ensuring the chest visibly rises with each breath. Pregnant women have increased oxygen consumption and reduced lung capacity, making effective ventilation and oxygenation important during cardiac arrest. Continue consistent compressions and breaths without significant pauses until emergency medical services arrive or the woman shows clear signs of recovery.
After Initiating CPR
Once CPR has been initiated and emergency medical services have been contacted, continue resuscitation efforts without interruption. Maintain CPR until professional medical personnel take over or the woman regains consciousness and breathes normally. The primary purpose of bystander CPR is to sustain blood flow and oxygen delivery to the mother and baby until advanced medical care can be provided.
Medical professionals will then assess the situation and implement advanced life support measures tailored to the pregnant patient. The immediate and continuous efforts of bystander CPR contribute to a positive outcome.