CPR for Pregnant Patients: Guidelines & Modifications
Cardiac arrest during pregnancy is a rare but critical event. Because of the physiological changes that occur during pregnancy, performing CPR on a pregnant patient requires specific adjustments to maximize the chances of both maternal and fetal survival. If you work in emergency medicine, obstetrics, anesthesia, or critical care, it’s vital to know how to modify your approach.
Why Pregnancy Changes CPR
During pregnancy—especially in the later stages—the uterus enlarges, diaphragm elevation reduces lung capacity, and blood volume and cardiac output increase.
By the second trimester, the gravid uterus can compress the inferior vena cava and aorta when the patient is lying flat, reducing venous return and cardiac output.
These factors mean that standard resuscitation techniques may not be as effective if not adjusted for pregnancy.
Key Modifications for Performing CPR on Pregnant Patients
1. Left Uterine Displacement (LUD)
Why: To relieve aortocaval compression and improve blood return to the heart.
How:
- Manually displace the uterus to the left using one or two hands, or
- Tilt the patient 15–30 degrees to the left (placing a wedge or pillow under the right hip).
When:
As soon as possible during chest compressions — do not delay CPR to achieve displacement.
2. High-Quality Chest Compressions
- Follow the same hand placement and depth (at least 2 inches/5 cm) as for non-pregnant adults.
- Perform compressions at the recommended rate of 100–120 per minute.
- Ensure minimal interruptions in compressions.
3. Airway and Breathing
- Pregnant patients are at higher risk of difficult airway and aspiration.
- Consider early airway management (endotracheal intubation).
- Use 100% oxygen.
4. Early Consideration of Perimortem Cesarean Delivery
Why: If ROSC (Return of Spontaneous Circulation) is not achieved within 4–5 minutes of arrest, performing an emergency cesarean can:
- Relieve aortocaval compression
- Improve maternal hemodynamics
- Offer a chance of neonatal survival
When:
If the pregnancy is ≥20 weeks (uterus palpable above the umbilicus), the resuscitation team should prepare for possible cesarean at the 4-minute mark of arrest.
5. Team Coordination
Managing cardiac arrest in pregnancy requires a multidisciplinary approach:
- Obstetrician
- Anesthesia
- Neonatology
- Emergency Medicine / ICU
Teams should practice drills and be prepared to work rapidly and collaboratively.
