8.1 High-Quality CPR During Pregnancy
Key Takeaways
Begin standard adult high-quality CPR immediately for a pregnant patient in cardiac arrest; pregnancy does not change the lower-half-of-the-sternum hand position.
Use an AED promptly and follow its prompts; pregnancy is not a reason to withhold or delay defibrillation.
When the uterine fundus is at or above the umbilicus, provide continuous manual left uterine displacement while another rescuer performs compressions.
Manual uterine displacement is performed in addition to CPR and is preferred to tilting the whole patient, which can degrade compression quality.
Activate the emergency response system early and request the resources identified in the local maternal-cardiac-arrest plan.
8.1 High-Quality CPR During Pregnancy
Cardiac arrest during pregnancy is uncommon, but hesitation can be fatal. The BLS response begins with the same priorities used for any adult: recognize cardiac arrest, activate the emergency response system, start high-quality chest compressions, provide breaths, and use an AED as soon as it is available. Pregnancy adds one important team action—manual left uterine displacement when the uterus is large enough to compress major abdominal blood vessels.
Start standard adult CPR
If the patient is unresponsive, has no normal breathing, and has no definite pulse within 10 seconds, begin adult CPR. Use these standard targets:
- Compression rate of 100-120/min.
- Depth of at least 2 inches (5 cm) while avoiding depths greater than 2.4 inches (6 cm).
- Hands on the lower half of the sternum.
- Complete chest recoil and interruptions of less than 10 seconds.
- A 30:2 compression-to-ventilation ratio until an advanced airway is in place.
- Each breath over about 1 second with visible chest rise.
Older teaching sometimes moved the compression hands higher on the sternum during pregnancy. Current AHA guidance does not support that change. Use the normal adult landmark so compressions remain effective.
Add manual left uterine displacement
In later pregnancy, the uterus can compress the inferior vena cava and aorta when the patient is supine, reducing blood return to the heart and limiting the blood flow produced by CPR. When the uterine fundus is at or above the level of the umbilicus, assign a rescuer to move the uterus manually toward the patient's left side.
The displacement rescuer stands on either side according to space and training and uses one or two hands to draw or push the uterus leftward. The goal is to relieve pressure on the great vessels while the patient remains flat on a firm surface for effective compressions. The rescuer maintains the displacement continuously and communicates if positioning or access changes.
Important
Manual left uterine displacement supplements CPR; it never replaces compressions, breaths, or AED use. Do not pause compressions to perform it.
Tilting the entire patient can make it harder to compress straight down over the sternum and may reduce compression quality. A supine position with manual displacement permits a second rescuer to address the uterus while the compressor preserves standard mechanics.
Use the AED normally
Apply the AED as soon as it arrives. Expose and dry the chest as needed, place the pads in the standard adult positions, clear the patient for rhythm analysis, and deliver a shock if advised. No one—including the rescuer performing uterine displacement—may touch the patient during analysis or shock delivery. Resume CPR immediately after the shock or a no-shock message.
Pregnancy is not a contraindication to defibrillation. The immediate danger of untreated cardiac arrest is much greater than a hypothetical delay made in an attempt to protect the fetus. Do not use pediatric attenuation for an adult solely because the patient is pregnant.
Organize the team and request help
A high-performance response assigns a compressor, airway rescuer, AED rescuer, and uterine-displacement rescuer as personnel become available. Activate emergency response early and tell dispatch or the responding team that the patient is pregnant. Facilities should follow their maternal-cardiac-arrest plan and mobilize obstetric, neonatal, and advanced resuscitation resources.
Decisions about advanced airways, medications, extracorporeal support, or resuscitative delivery belong to appropriately trained teams and local protocols. A BLS provider should recognize that those resources are urgent without delaying the core BLS actions to debate an advanced procedure.
Exam decision pattern
For a pregnant adult with cardiac arrest, choose the answer that preserves standard high-quality adult CPR and early AED use. If the fundus is at or above the umbilicus and another rescuer is available, add manual left uterine displacement. Reject answers that move the compression landmark, tilt the patient in a way that compromises compressions, delay defibrillation, or stop CPR for a pregnancy-specific intervention.
Team rehearsal
Use a manikin and a folded towel to represent the uterus. One rescuer starts standard adult CPR, another applies the AED, and a third provides continuous left uterine displacement without touching the patient during AED analysis or shock. The team should discover that the added role requires planning but does not change hand placement, rate, depth, ratios, or defibrillation priority. Repeat with only two rescuers and decide which tasks must occur first as additional help is summoned.
Where should a rescuer place the hands for chest compressions on a pregnant adult in cardiac arrest?
On the lower half of the sternum, using the standard adult landmark
Over the upper third of the sternum because pregnancy raises the heart
Directly over the uterine fundus
On the left lower ribs
What pregnancy-specific action should be added when the uterine fundus is at or above the umbilicus?
Delay CPR until an obstetrician arrives.
Have another rescuer provide continuous manual left uterine displacement.
Tilt the patient enough that chest compressions cannot be delivered vertically.
Use pediatric AED pads to reduce shock energy.
How should an AED be used during cardiac arrest in pregnancy?
Only after 10 minutes of CPR
Only if fetal monitoring confirms distress
Promptly, with standard adult pad placement and the usual clear commands
With both pads placed on the back
Sections you finish are checked off in the contents.