Mastering techniques for performing CPR on a pregnant woman is critical for healthcare professionals everywhere. Expectant mothers require an additional level of consideration and care, as they may have heightened sudden cardiac arrest risk factors and need specialized temperature management.

Here’s a comprehensive look at the intricacies of performing in-hospital CPR on pregnant women and essential post-CPR care guidelines.

Heightened Cardiac Arrest Risk Factors for Pregnant People

Pregnancy alters a person’s physiology, leading to an increased risk of sudden cardiac arrest compared to the general population. In fact, about 1 in 9,000 in-hospital pregnancies are complicated by cardiac arrest.

Several factors contribute to an increased risk of sudden cardiac arrest among pregnant people.

• Age-Related Considerations

  Advanced maternal age — defined as 35 years or older — elevates the risk of pregnancy-related complications, including cardiac issues. Women aged 40 and older face nearly eight times the risk of pregnancy-related death compared to those aged 25 and younger, with conditions such as chronic high blood pressure, preeclampsia and gestational diabetes becoming more prevalent.

• Obesity and Weight Management

  Obesity, defined by a body mass index of 30 or higher, is a substantial risk factor for pregnancy complications, including cardiac-related issues like preeclampsia and gestational diabetes. Excessive weight gain during pregnancy can further exacerbate these risks.

• Cardiovascular Disease

  Cardiovascular disease, the leading cause of maternal death in the United States, poses a significant risk for pregnant people. Conditions such as heart disease and stroke contribute to more than a quarter of pregnancy-related deaths annually.

• Racial Disparities

  Racial inequities also play a role in heightened sudden cardiac arrest risk among pregnant people. Black people face increased risks across various age groups compared to white people, with disparities in access to quality healthcare and socioeconomic factors contributing to these differences.

• Medical Conditions

  Preexisting medical conditions can further elevate the risk of cardiac complications during pregnancy, such as:

  • Hypertension
  • Heart conditions
  • Preeclampsia
  • Diabetes
  • Multiple gestations
  • Sleep apnea

4 Tips for Performing CPR on a Pregnant Person

During maternal sudden cardiac arrest, a structured approach combining basic life support (BLS) and advanced cardiovascular life support (ACLS) interventions is crucial for optimizing outcomes. Consider the potential causes of sudden cardiac arrest, and tailor the interventions accordingly. Here’s a breakdown of key steps and interventions to consider.

• 1. Initiate High-Quality CPR Promptly

  Critical components of high-quality CPR for adults include:

  • Chest compression fraction of greater than 80%, to minimize interruptions of chest compressions and maximize coronary profusion
  • Chest compression rate of 100 to 120 per minute
  • Chest compression depth of 2 inches to 2.4 inches
  • Allow for full recoil of the compressed chest
  • Avoid excessive ventilation

• 2. Continue BLS/ACLS

  • Defibrillate if indicated by the cardiac rhythm.
  • Administer other ACLS interventions as necessary, such as epinephrine.

• 3. Perform Maternal Interventions

  • Manage the airway effectively, ensuring proper ventilation with 100% oxygen while avoiding excessive ventilation.
  • Establish intravenous access above the diaphragm for administering medication.
  • If the patient is receiving intravenous magnesium, discontinue and administer calcium chloride or gluconate as needed.

• 4. Perform Obstetric Interventions

  • Provide continuous lateral uterine displacement to alleviate vena cava compression and optimize maternal circulation.
  • Detach fetal monitors to focus on maternal resuscitation efforts.
  • Prepare for perimortem cesarean delivery if indicated.
  • Consider immediate perimortem cesarean delivery if a return of spontaneous circulation (ROSC) isn’t achieved within five minutes of resuscitation efforts.

Considerations for CPR and Post-CPR Care on a Pregnant Person

The 2020 American Heart Association Guidelines for CPR and ECC provide updated recommendations for managing sudden cardiac arrest in pregnancy. It highlights the importance of prioritizing airway, ventilation and oxygenation during CPR on a pregnant woman. The unique physiological changes during pregnancy — including increased metabolism, reduced functional reserve capacity due to the gravid uterus and the heightened risk of fetal brain injury from hypoxemia — underscore the necessity of focusing on these elements.

• Prioritize Oxygenation and Airway Management

  Due to increased susceptibility to hypoxia, focus on ensuring optimal oxygenation and managing the airway effectively during resuscitation from sudden cardiac arrest in pregnancy.

• Avoid Fetal Monitoring

  Refrain from fetal monitoring during maternal resuscitation to prevent potential interference with the resuscitation process.

• Leverage Targeted Temperature Management

  If the patient remains comatose after cardiac arrest resuscitation, consider targeted temperature management as recommended.

• Use Continuous Fetal Monitoring During Temperature Management

  After initiating targeted temperature management, ensure continuous fetal monitoring for potential bradycardia as a complication, alongside obstetric and neonatal support.

Ensuring Healthcare Providers Are Equipped with Lifesaving Skills

Staff education is the most effective way to improve patient outcomes. By routinely practicing high-quality CPR and having the knowledge and skills needed to perform CPR on a pregnant person, healthcare professionals can enjoy heightened competency and confidence in hospital settings.

To learn more about effective CPR training courses, explore the Resuscitation Quality Improvement (RQI) Program.