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 – Pregnancy increases a mother’s need for oxygen, making early and effective CPR critical.
• Enlarged uterus compresses major blood vessels – In the third trimester, the uterus can compress the inferior vena cava, reducing blood return to the heart.
• Higher risk of airway swelling and aspiration – Pregnancy-related hormonal changes can cause swollen airways, making intubation and ventilation more difficult.

How to Modify BLS for Pregnant Patients

1. Prioritize High-Quality Chest Compressions

• Perform compressions at the standard rate of 100-120 per minute.
• Compression depth remains the same as non-pregnant adults: at least 2 inches (5 cm).
• Ensure full chest recoil between compressions.

2. Left Uterine Displacement (LUD) to Improve Circulation

• In the third trimester, the uterus can compress the inferior vena cava, reducing blood return to the heart.
• To relieve this pressure:
  • Manually displace the uterus to the left while performing compressions.
  • If a backboard is available, tilt the patient 15-30° to the left.

3. Airway & Ventilation Considerations

• Use head tilt-chin lift unless trauma is suspected.
• Expect increased airway resistance—use higher ventilation pressures if needed.
• Monitor for gastric inflation, as pregnancy increases aspiration risk.

Emergency Perimortem Cesarean Section (C-Section)

In cases of maternal cardiac arrest after 20 weeks of gestation, an emergency C-section (perimortem delivery) may be necessary if resuscitation is unsuccessful within 4-5 minutes.

Key Considerations for Emergency C-Section

• Performed to relieve aortocaval compression, improving maternal circulation.
• Best chance for fetal survival occurs if delivery is within 5 minutes of maternal arrest.
• Should only be attempted by trained personnel in a hospital setting.

Key Takeaways: BLS for Pregnant Patients

• Perform high-quality chest compressions without modification.
• Use left uterine displacement (LUD) or tilt the patient left to improve blood flow.
• Be prepared for difficult airway management due to pregnancy-related changes.
• Consider emergency C-section if maternal cardiac arrest occurs after 20 weeks gestation and resuscitation is not immediately successful.

Recognizing these special considerations ensures optimal outcomes for both the mother and fetus.

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