7.1 BLS for Pregnant Patients

Performing CPR on a pregnant patient presents unique challenges due to the physiological changes that occur during pregnancy. Healthcare providers must adjust their resuscitation approach to maximize survival for both the mother and fetus.

Key Physiological Changes in Pregnancy

• Increased cardiac output and oxygen demand – Early and effective CPR is critical due to heightened oxygen needs.
• Enlarged uterus compresses major blood vessels – Especially in the third trimester, the uterus can compress the inferior vena cava and reduce blood return to the heart.
• Higher risk of airway swelling and aspiration – Swollen airways may complicate ventilation and intubation efforts.

1. Prioritize High-Quality Chest Compressions

• Use a rate of 100–120 compressions per minute.
• Compression depth remains at least 2 inches (5 cm).
• Ensure full chest recoil between compressions.

2. Left Uterine Displacement (LUD)

• Displace the uterus to the left manually or tilt the patient 15–30° to the left if a backboard is available.
• Reduces pressure on the inferior vena cava and improves maternal circulation.

3. Airway & Ventilation Considerations

• Use a head tilt–chin lift unless trauma is suspected.
• Expect increased airway resistance—higher ventilation pressure may be needed.
• Monitor closely for gastric inflation and aspiration risk.

Emergency Perimortem Cesarean Section

If maternal cardiac arrest occurs after 20 weeks gestation and resuscitation is unsuccessful within 4–5 minutes, consider emergency cesarean delivery.

• Relieves aortocaval compression and improves maternal blood flow.
• Improves fetal outcomes if delivery occurs within 5 minutes of maternal arrest.
• Should only be performed by trained personnel in a hospital setting.

Key Takeaways

• Perform standard, high-quality compressions—no depth modification is needed.
• Apply left uterine displacement (LUD) to improve maternal circulation.
• Anticipate airway challenges and ventilate carefully.
• Emergency C-section may be lifesaving after 20 weeks if resuscitation fails within 4–5 minutes.

Next, we’ll discuss how to adapt BLS for trauma patients, where spinal injuries, bleeding, and airway compromise present additional challenges.