Review Note
Last Update: 03/27/2025 10:54 PM
Current Deck: ACG Part 2::Obstetrics
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Commit #309819
SS_OB 1.39 Discuss the differences in basic and advanced life support in the pregnant woman
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Commit #309819Effective resuscitation is the best way to optimise foetal outcome
ALS MODIFICATIONS
- Call for obstetrician and neonatologist immediately
- Start standard BLS
- Prepare early for emergency hysterotomy (perimortem caesarean section)
- If over 20 weeks pregnant or the uterus is palpable above the level of the umbilicus, add a wedge to give left lateral tilt (pillow or knees of chest compression person), aim for 15-30 degrees
- You may need to manually displace the uterus to the left to remove caval compression
- A small amount of tilt is better than no tilt, tilt needs to still facilitate CPR
- Hands in standard position on lower half of the sternum if feasible for chest compressions. (MRI showed no significant vertical displacement of heart in third trimester)
- Consider early intubation (watch for reflux / engorged upper airway) - ideally skilled operator
- Defibrillation pads under L breast and below R clavicle
- Remove CTG/fetal scalp electrode prior to defibrillation
- If over 20 weeks pregnant or the uterus is palpable above the level of the umbilicus and immediate (within 4 mins) resuscitation is not successful, deliver the fetus by emergency hysterotomy aiming for delivery within 5 mins of collapse.
- continue high quality chest compressions
- assisted vaginal birth with forceps or vaccum is appropriate if cervix fully dilated , the fetus is low station acnd can occur within 5 minutes
- Establish IV access above the diaphragm to ensure delivery of drugs
Physiological changes of pregnancy (increased cardiac output, blood volume, minute ventilation, oxygen consumption and reduced lung volumes incl FRC) mean hypoxia occurs early
No RCTs exist to compare specialised obstetric resuscitation to standard care in the post-arrest pregnant woman
