Performing cardiopulmonary resuscitation (CPR) on a pregnant woman can be a daunting task, as there are specific considerations to ensure the safety of both the mother and the baby. In the UK, it is crucial for individuals trained in CPR to be familiar with these adjustments in order to respond effectively during an emergency situation involving a pregnant woman.
When administering CPR to a pregnant woman, certain factors such as the woman’s physical condition, the stage of pregnancy, and the availability of specialized equipment need to be taken into account. High-quality chest compressions should be performed immediately and continued until the return of spontaneous circulation, as stated in the clinical guidelines by the Obstetric Anaesthetists’ Association. Additionally, it is essential to call 999 and inform the operator that the patient is pregnant to ensure that emergency medical services can respond accordingly.
In this article, we will discuss the recommended modifications and key points to be aware of when providing CPR to a pregnant woman in the UK, based on current medical guidelines and expert advice. This knowledge is crucial for anyone trained in CPR, as it may make the difference in saving the lives of both the expecting mother and her baby during a critical event.
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Understanding CPR in Pregnancy
Performing CPR on a pregnant woman may require slight adjustments in the technique to account for the mother and the unborn baby’s safety. The principles of CPR remain the same, but there are certain considerations to keep in mind.
During a cardiac arrest, the goal of CPR is to circulate oxygen-rich blood to the vital organs, including the brain and the heart. In pregnant women, it is crucial to also ensure adequate blood flow to the placenta and the fetus. Chest compressions should be performed with firm pressure in the centre of the chest at a rate of 100-120 beats per minute, as advised for any CPR patient.
Automated External Defibrillator (AED) use is considered safe for pregnant women, and it poses no harm to the unborn baby. If an AED is available, it should be used promptly to deliver shocks as needed.
Although there are no specific CPR position alterations for pregnant women, they may require additional support to elevate their right hip. Elevating their right hip helps reduce compression of the inferior vena cava, which is the primary blood vessel returning blood from the lower body to the heart. This can be achieved by placing a rolled-up towel, cushion, or blanket under their right hip.
Modifications for Pregnant Women
When performing CPR on a pregnant woman, you should make a few modifications to ensure the safety of both the mother and the baby. The key is to adapt your technique to accommodate the unique needs of a pregnant patient.
Firstly, it is important to inform emergency services that the person needing CPR is pregnant, so they can provide appropriate assistance and be prepared for the situation.
During chest compressions, place your hands slightly higher than usual. This is because the pregnant woman’s diaphragm is elevated, and her heart is positioned higher in her chest.
If possible, someone else should manually displace the pregnant woman’s uterus to her left side, in a technique called “left lateral tilt.” This helps to relieve pressure on her inferior vena cava, ensuring proper blood flow to her heart and the baby. A few ways to achieve the left lateral tilt include:
- Placing a rolled-up blanket or wedge under the right side of her back
- Manually tilting the pregnant woman’s hips and shoulders to the left
- Positioning her on her left side and tilting her top leg forward
If multiple rescuers are present, ensure that someone is responsible for rescuer-airway management, applying suction to aspirate vomit and inserting an airway when needed.
Lastly, be prepared to perform CPR for a longer duration, as it can take time for the woman’s body to react to the newly oxygenated blood due to the increased blood volume during pregnancy.
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Step-by-Step CPR Guide
Performing CPR on a pregnant woman is similar to performing CPR on any other individual, but with a few small adjustments. Follow these steps:
- Recognise Maternal Cardiac Arrest & Call 999 – Make sure the person is unresponsive and not breathing or only gasping for air. Call emergency services immediately.
- Shake and Shout – Check for responsiveness by shaking the person gently and asking if they are okay. If there is no response, proceed with CPR.
- Positioning – To facilitate blood flow for both the pregnant woman and the baby, place a rolled-up towel or a small pillow under the right hip. This helps to tilt her slightly to the left side.
- Chest Compressions – Place your hands in the center of the chest, one on top of the other, and begin chest compressions. Push hard and fast, maintaining a rate of 100-120 compressions per minute.
- Rescue Breaths – If you are trained in CPR, you can give rescue breaths after 30 chest compressions. Tilt the head back, lift the chin, pinch the nose, and breathe into the mouth for 1 second. Repeat this twice before continuing with chest compressions. If you are not trained, continue with compression-only CPR.
- Use an AED – As soon as an AED becomes available, turn it on and follow the prompts. Ensure the woman’s chest is clear of any metal, including underwire bras and necklaces, before attaching the pads.
Continue CPR until medical assistance arrives, the woman shows signs of life, or you become too exhausted to continue.
Special Considerations for the UK
In the UK, efforts for effectively providing CPR to pregnant women remain consistent with global guidelines, with certain nuances to consider. It is crucial to follow the steps of CALL and PUSH, which involve recognising maternal cardiac arrest and calling emergency services, followed by performing chest compressions.
When performing CPR on a pregnant woman in the UK, take note of these specific considerations:
- For compressions, apply a leftwards displacement of the uterus by a quantity of 15 degrees or more. This action, called the manual uterine displacement, allows for improved chest compressions and reduces the risk of aortocaval compression in pregnant women.
- In the UK, chest compressions should be administered at a rate of 100-120 compressions per minute, which follows a 15:2 compression-to-ventilation ratio, as mentioned in the PMC article.
- It is important to relay to the 999 dispatcher that the woman experiencing cardiac arrest is pregnant. This allows the emergency services to be well-prepared for any specific requirements or special equipment needed upon arrival.
By following these guidelines and adapting standard CPR techniques to accommodate the needs of pregnant women, bystanders can increase the chances of survival for both the mother and the fetus in the UK setting.
Calling Emergency Services in the UK
When encountering a situation where a pregnant woman requires CPR, it’s crucial to call emergency services in the UK right away. To do this, dial 999 and request an ambulance.
As you speak with the call-taker, make sure to inform them that the woman requiring assistance is pregnant. This crucial piece of information will allow emergency medical services (EMS) personnel to prepare their response accordingly and arrive on scene with the right equipment and knowledge to handle the situation effectively.
While waiting for EMS to arrive, it’s important to begin providing CPR to the pregnant woman, following the proper techniques and modifications as needed. Continue to perform CPR until the ambulance arrives and professional help takes over.
Here are a few important bullet points when calling emergency services in the UK:
- Dial 999 to request an ambulance.
- Inform the call-taker about the woman’s pregnant status.
- Stay on the line and follow any guidance provided by the operator.
- Begin CPR immediately after the call and continue until help arrives.
By following these steps, you can ensure the best possible chance of survival for the pregnant woman and her unborn child. Remember, in cases of emergency, acting quickly and calling for help are essential actions to take.
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Post-CPR Care and Monitoring
Following the successful completion of CPR on a pregnant woman, it is crucial to provide appropriate post-CPR care and monitoring. This helps ensure proper recovery and helps reduce the risk of complications for both the mother and the unborn baby.
Upon the arrival of emergency services, they will take over the care of the pregnant woman, and will likely transport her to a hospital for further assessment and treatment. It is essential to provide the medical professionals with any pertinent details about the woman’s condition, including her pregnancy status and any unique complications she may have experienced.
During the period of hospitalisation, the healthcare team will monitor the mother and baby closely. Some key aspects of post-CPR care and monitoring may include:
- Assessing maternal vital signs – Regular checks of blood pressure, heart rate, oxygen levels, and other vital signs will be conducted to ensure the woman’s stability.
- Cardiac monitoring – Continuous electrocardiogram (ECG) monitoring of the mother’s heart may be performed to detect any abnormalities.
- Fetal heart monitoring – The healthcare team will also monitor the baby’s heart rate, using either an external or internal monitoring device, to ensure the baby’s well-being.
- Neurological assessment – The medical team may assess the neurological status of the mother to detect any neurological damage that may have occurred during the cardiac arrest.
- Optimising maternal positioning – The medical team may position the mother to minimise aortocaval compression and ensure optimal blood flow to the baby.
Throughout the recovery process, the healthcare team will work together to address any issues and provide the necessary interventions to ensure the best possible outcome for both the mother and her unborn child.
Conclusion
In summary, performing CPR on a pregnant woman requires a slightly different approach compared to standard CPR techniques. It is important to make the necessary adjustments to ensure the effectiveness of the resuscitation efforts and the safety of both the mother and the foetus.
When providing CPR to a pregnant woman, follow these essential steps:
- Recognise maternal cardiac arrest and call emergency services
- Place the woman in a left lateral tilt position to alleviate aortocaval compression
- Perform chest compressions and rescue breaths, adjusting compression location if necessary
It is crucial for medical professionals and laypersons alike to be familiar with these guidelines in order to respond appropriately to a maternal cardiac arrest situation. Remember that the primary goal is to save both the mother and the foetus by optimising resuscitation efforts.
The updated Resuscitation Council UK guidelines and the Cardiopulmonary Resuscitation in Pregnancy guidance provide essential information on this topic. Regular training and education on these recommendations will help ensure a timely and effective response to maternal cardiac arrest situations.
See more on performing adult CPR and child CPR. Skills Training Group delivers CPR courses nationwide, please contact us for any of your training needs.
