Looking to learn how to perform CPR on a pregnant woman? We can help! When a pregnant woman experiences cardiac arrest, it can be an unexpected and dangerous situation to encounter. With this in mind, it is essential to understand how to perform cardiopulmonary resuscitation (CPR) on a pregnant woman.
This blog will answer key questions, such as what is maternal cardiac arrest and how to perform CPR on a pregnant woman step by step. Furthermore, we will highlight the commonality of maternal heart attack and discuss the American Heart Association Algorithm for Advanced Maternal Resuscitation and the use of automated external defibrillators (AEDs). This will also highlight the importance of why it’s worth it to get CPR certified.
What Is Maternal Cardiac Arrest and How to Perform CPR on a Pregnant Woman
Maternal cardiac arrest is a life-threatening medical emergency that can occur during pregnancy, childbirth, or in the postpartum period. It is an uncommon but potentially fatal condition resulting from any type of heart disease, including arrhythmias or cardiomyopathy and underlying health conditions such as eclampsia or pre-eclampsia.
Unfortunately, maternal mortality in the US has grown, which makes caring for pregnant women in these cases more important. When maternal cardiac arrest occurs, it is essential to intervene quickly and appropriately in order to save both the mother’s and baby’s lives. Without effective intervention within minutes, the risk of mortality increases dramatically for both patient and fetus alike.
Is Maternal Cardiac Arrest Common?
CPR on pregnant women is not a common occurrence. In fact, it occurs once in around 30,000 pregnancies. However, this doesn’t mean that staff, especially those that want to work in the medical field, should pay little attention to the correct way of giving CPR in these situations.
Despite the complex physiology involved with this condition, early recognition of signs and symptoms coupled with prompt intervention may result in successful resuscitation efforts leading to improved maternal and fetal survival rates.
What Causes Maternal Cardiac Arrest?
Any type of heart disease, including arrhythmias or cardiomyopathy, and underlying health conditions such as eclampsia or pre-eclampsia can cause this life-threatening condition. Unfortunately, due to its rarity, maternal cardiac arrest often goes unrecognized and untreated until it is too late, resulting in adverse outcomes for both mother and baby.
In most cases, maternal cardiac arrest occurs due to:
- Bleeding;
- Heart failure;
- Sepsis;
- Amniotic fluid embolism.
Performing CPR on a Pregnant Woman
When performing CPR on a pregnant woman, it is important to remember that you have two people you need to take care of: the mother and the baby. In the unfortunate event that childbirth complicates with cardiac arrest, the neonates require neonatal care that will include CPR. One study showed that in such cases of obstetrical emergencies, 79% of neonates that required CPR were placed under mechanical ventilation, while 90% required central venous access.
How To Perform CPR On A Pregnant Woman: Step-by-Step Guide
When a pregnant woman falls into cardiac arrest, medical intervention is of high importance. Giving CPR to a pregnant woman follows the same steps as giving CPR to any other cardiac arrest victim. However, there is a higher level of caution that needs to be exerted here.
To give a better picture of how CPR on pregnant women should be done, here is a simple step-by-step guide:
- Place the patient’s left side down or turn her onto the back in order to prevent compression of the uterus.
- Kneel at her head so you don’t unintentionally kick or hurt, in any other way, the fetus.
- Start delivering chest compressions with two hands placed over the sternum; avoid the abdominal area. Compressions should be delivered at a rate of 100-120 per minute, and each compression should push down ⅓ to ½ of an inch deep into the chest wall.
- Follow the CBA sequence, and after the compressions, give rescue breaths. You can also use a bag-valve-mask device or face shield for oxygen delivery instead of mouth-to-mouth resuscitation.
- If you need to use an AED for shock delivery, it is essential not to apply pads directly over any areas on the right side of the chest or abdomen as this may adversely cause fetal distress, affect the fetus’ heart rate, or even cause placental abruption.
- Follow the CBA sequence, and after the compressions, give rescue breaths. You can also use a bag-valve-mask device or face shield for oxygen delivery instead of mouth-to-mouth resuscitation.
- After every cycle (30 compressions followed by 2 breaths), check for signs of life, such as palpable pulse and spontaneous respirations. If there is no pulse, repeat the same process until an emergency response unit arrives to transport her to a hospital.
Note that sometimes CPR can take more time for the circulation to bring the wanted results, so you may feel fatigued after several tries. This is why it’s best to contact this technique in teams of two.
Factors That Influence CPR in Pregnant Women
Although CPR should be administered immediately after a pregnant victim falls into cardiac arrest, there are several factors that are more common with pregnant women you need to have in mind before starting the process, as these can hinder or worsen the situation. Those include the following:
- Anatomical changes – These can make administering rescue breaths more difficult because they usually obstruct the airway.
- Pathological changes – The most common case is laryngeal edema. This condition usually occurs in allergies and injuries to the larynx, which causes an accumulation of fluid in the tissue of the larynx. As such, it can obstruct the airways and make giving CPR more difficult.
- Psychological factors – During pregnancy, a female’s hormones act differently, which may also result in signs of some unusual acts like increased ventilation, increased oxygen demand, etc. These can also lead to other issues, such as raising the risk of regurgitation, intragastric pressure, etc.
Cardiac Arrest Survival Chances in Pregnant and Non-Pregnant Women
A study concluded that the survival rate of cardiac arrest female victims in the ED was better in pregnant women than in non-pregnant ones. This was both for situations with traumatic injuries and those without such results.
Interestingly enough, this study is not the only one that has proven this. A cross-sectional study using the Nationwide Inpatient Sample database backed up the findings of the first study, proving that mortality rates in pregnant women lowered when they were given CPR compared to the rates with non-pregnant women.
Namely, this study showed that after CPR, the mortality rate for pregnant women was 49.4%, while that for non-pregnant women was 71.1%. The problem, however, is that the reasons behind this phenomenon were not clear in both studies. This is why it’s important to learn how to perform CPR on a pregnant woman.
AHA Algorithm for Advanced Maternal Resuscitation
The American Heart Association (AHA) has developed a comprehensive algorithm for advanced maternal resuscitation focusing on early detection followed by prompt initiation of life-saving measures such as chest compressions, airway management, and medication when indicated.
The AHA’s Maternal Cardiac Arrest Algorithm emphasizes avoiding direct pressure on the abdomen while delivering chest compressions. In addition, rescue breathing should be avoided and given only in dire situations. In those cases, it’s advised to use a bag-valve-mask device or face shield instead of mouth-to-mouth. Finally, healthcare providers must take extra precautions when using an AED for shocks as these can severely damage the fetus if placed and used wrong.
Overall, implementation and adherence to the AHA’s advanced maternal resuscitation algorithm can help ensure optimal outcomes for both mother and baby when responding to maternal cardiac arrest.
Takeaway: Should You Use CPR on a Pregnant Woman?
When facing a cardiac arrest in pregnant women, just like in any other case, CPR is the first step in making sure the woman and the fetus survive. These situations are undoubtedly more complicated as you need to pay attention to rescuing the mother but also not hurting the fetus in any way.
Although rare, healthcare providers must be properly trained and equipped on the appropriate use of life-saving measures such as CPR in these cases. One study even concluded that 97.5% of medical staff consider training on CPR for pregnant women essential.
Aside from the usual CBA sequence of giving CPR, medical staff and all those willing to learn this technique, particularly for administering it to pregnant women, need to be aware of the correct use of additional devices like AEDs or medications.
Luckily, there are countless training centers and health providers that can teach you how to correctly and quickly perform CPR on a pregnant woman. That way, you can make sure to lend a helping hand in such dire situations and improve the chances of survival for both the mother and fetus. This should all help you understand when and how to perform CPR on a pregnant woman.