Obstetric cardiac arrest
Cardiac arrest in pregnancy is uncommon but time‑critical. Management follows standard adult advanced life support (ALS) but must be adapted for pregnancy physiology, the gravid uterus and pregnancy‑specific causes.
Rapid multi‑disciplinary activation, high‑quality CPR with uterine displacement, early airway control, timely defibrillation and early preparation for resuscitative hysterotomy are the priorities (Resuscitation Council UK; RCEM). This chapter summarises practical, exam‑relevant actions and decision points.
Red Phone ALERT - immediate actions (first seconds/minutes)
Announce “Maternal cardiac arrest” and activate a multi‑disciplinary response immediately: obstetrics (consultant + midwife), neonatal resuscitation team, anaesthetics/ICU, blood bank / Major Haemorrhage pathway, ED resuscitation and surgical support. Allocate roles: ALS lead, airway, chest compressions, obstetric lead, neonatal lead, scribe/timekeeper.
While teams are mobilising:
- Start high‑quality CPR without delay (compressions rate/depth per ALS).
- Manually displace the uterus to the left and maintain displacement throughout compressions (preferred over a lateral tilt that impairs CPR).
- Attach monitor/defibrillator and treat shockable rhythms per usual ALS-do not withhold defibrillation for pregnancy.
- Secure airway early: plan for endotracheal intubation by the most experienced operator; use capnography.
- Obtain vascular access above the diaphragm (upper limb) or intraosseous (IO) if needed.
- If the uterus is palpable at or above the umbilicus (pragmatic ≈≥20 weeks) or foetal viability is suspected, prepare for resuscitative hysterotomy early. If there is no return of spontaneous...