How to Perform CPR on a Pregnant Person

Confusion Around Maternal Cardiac Arrest

How do you perform CPR on a pregnant woman? Although sudden cardiac arrest (SCA) during pregnancy is rare, this commonly asked question highlights special nuances for resuscitation. 

Cardiac arrest occurs in about 2 pregnant people per 100,000 compared to 20 per 100,000 females of child bearing age. However, during cardiac arrest, pregnant women are more vulnerable to oxygen deprivation because the fetus requires significant amounts of oxygen from the mother. Fluctuation of hormones like progesterone and estrogen during pregnancy also restrict air passages and intensify the dangers associated with maternal cardiac arrest.

How to Respond When Performing CPR on a Pregnant Woman

Call 911

The first step upon recognizing a cardiac arrest in a pregnant person is the same as for anyone else: call 911 for help. Be sure to report that the person in cardiac arrest is pregnant. This ensures activation of hospital obstetrics and neonatal resuscitation teams, which will be crucial for the survival of both mother and child. If possible, seek assistance from other nearby bystanders. Send one to seek out a nearby AED and have at least one other on hand to assist with CPR. 

High-Quality CPR with Uterine Displacement

High-quality cardiopulmonary resuscitation (CPR) is the primary component in surviving from a cardiac arrest while waiting for emergency medical services to arrive. However, as one rescuer is performing compressions, a second rescuer should perform a uterine displacement.

The uterus can be displaced in a couple of ways:

• From the right of the victim, gently push the uterus away with one hand.

• From the left of the victim gently pull the uterus towards yourself with two hands.

Regardless of which method is used, the uterine displacement improves blood flow during compressions.

Ventillations

Airway control is crucial due to the increased demand for oxygen during pregnancy. After performing 30 chest compressions, give two rescue breaths per cycle. When performing rescue breaths, use the head-tilt, chin-lift method to open the airway and ensure to see the chest rise for air flow. If available in the AED kit, use a pocket-mask to deliver oxygen to the lungs and the rest of the body. A pocket-mask protects the rescuer with a one-way valve that prevents any exchange of bodily fluids. Always maintain a steady rhythm to prevent hyperventilation, which lowers carbon dioxide levels and reduces blood flow to the brain.

Apply AED

AED use is safe in all stages of pregnancy. Before applying an AED, remove any clothing covering the chest or where the AED pads will be placed. If necessary, wipe the chest dry. Each unit should contain the essential equipment to deliver a shock safely on the victim. The contents may vary, but the following is a list of standard items included in an AED kit:

• Shears
• Cleansing Wipes
• Breathing Barrier or Pocket Mask
• Disposable Razor
• Disposable Gloves

According to the American Heart Association (AHA), 45% of men receive bystander CPR compared to only 39% of women. Some bystanders might be hesitant at the idea of removing clothing or touching the breasts of a woman to perform CPR or use an AED. It is imperative to educate the public that there is no difference in performing CPR on a man or woman when it involves saving a life.

Once the chest is cleared of clothing, turn on the AED and follow the voice prompts. Apply the AED pads to the pregnant person with traditional anterolateral pad placement where one pad is positioned on the right side of the victim’s chest, beneath the clavicle, or collarbone. The corresponding pad is placed on the left side of the victim’s chest, below the pectoral muscles.

Fetal monitors should not deter rescuers from using defibrillation. 

Repeat Until EMS Arrives

Continue these steps until emergency medical services (EMS) arrive and take over treatment. According to the American Heart Association®, immediate CPR can double or triple a victim’s chance of survival and 9 in 10 cardiac arrest victims who receive a shock from an AED in the first minute survive. But for every minute that passes without defibrillation, survival rates drop 7-10% percent.

Be Prepared With CPR Training Classes

Knowing the nuances of CPR for a pregnant person in cardiac arrest gives rescuers confidence to take action immediately when every second matters. 

This procedure is covered in Basic Life Support (BLS) training as part of the essential skills when performing CPR on a pregnant person. Code One CPR training offers approved American Heart Association® online BLS, ACLS, and PALS certification to build knowledge and skills in these situations.

For more information, please reference the American Heart Association® BLS Algorithm for Maternal Cardiac Arrest below: