The sudden stop of effective circulation and breathing in a pregnant or postpartum woman, typically within 6 weeks of delivery in a hospital setting, is known as Maternal Cardiac Arrest (MCA) in-hospital. It requires immediate action to restore the mother’s heartbeat and prevent a lack of oxygen to the baby. Unlike typical cardiac arrest, pregnancy brings unique challenges such as aortocaval compression, rapid hypoxia, difficult airways, and the urgent need to save two lives at once. Doctors and nurses quickly begin chest compressions, give oxygen, and use medicines to restart the heart. If the heart doesn’t restart within 4-5 minutes and the pregnancy is 20 weeks or more, an emergency C-section may be performed right there to help save both the baby and the mother. Without fast, specialized care, outcomes can be devastating for both.
According to the National Institutes Of Health 2023 March 14 Among 10 921 784 U.S. delivery hospitalizations, the cardiac arrest rate was 13.4 per 100 000. Of the 1465 patients who had cardiac arrest, 68.6% (95% CI, 63.2% to 74.0%) survived to hospital discharge.
Why is the standard ACLS algorithm important? The answer lies in pregnancy’s physiologic changes demanding left uterine displacement, early perimortem C-section, and modified resuscitation tactics. This is why specialized maternal ACLS protocols are not just beneficial, they’re lifesaving.
Cardiac arrest during pregnancy is a rare but serious event, and it can occur due to several factors. Here are the main causes and other causes too:
Cardiac arrest in pregnant women can also result from trauma, severe allergic reactions, drug toxicity, and complications related to anesthesia.
Pregnancy brings about significant physiological changes that support the developing fetus and prepare the mother for childbirth. Understanding these adaptations is essential for providing safe and effective care during pregnancy and delivery.
The heart works harder, and blood pressure can drop easily when lying flat on the back because the growing uterus presses on a large blood vessel (the vena cava), reducing blood flow back to the heart.
-The mother can run out of oxygen faster if her breathing stops.
-It can be trickier to manage her airway during resuscitation.
-Medications used during resuscitation might need adjusting.
-The baby’s health can also be affected by drugs given to the mother.
Cardiac arrest during pregnancy is a rare but life-threatening emergency that requires rapid, specialized care. The In-Hospital ACLS Algorithm for pregnancy guides healthcare teams with clear, step-by-step actions to manage the mother’s cardiac arrest while considering the baby’s safety.
Cardiac arrest during pregnancy is a rare but life-threatening emergency that requires rapid, specialized care. The In-Hospital ACLS Algorithm for pregnancy guides healthcare teams with clear, step-by-step actions to manage the mother’s cardiac arrest while considering the baby’s safety.
01.
ACLS begins with high-quality CPR ( cardiopulmonary resuscitation) to keep blood flowing to the heart and brain. If needed, an advanced external defibrillator (AED) is used to deliver a shock for life-threatening heart rhythms such as ventricular fibrillation (V-fib) and pulseless ventricular tachycardia (pulseless V-tach). Medications like epinephrine are given to help restart the heart and improve blood flow. Other advanced interventions, such as securing the airway and monitoring heart rhythms, are also part of ACLS care.
Quickly assemble a maternal cardiac arrest team, including obstetric (a branch of medical science focused on childbirth and the related stages of pregnancy and postpartum), an anesthesiologist (a doctor specialized in pain management), neonatal, and critical care specialists, to provide coordinated, specialized care during resuscitation.
03.
Identify and treat the possible etiology of the cardiac arrest, such as bleeding, blood clots, heart problems, or other pregnancy-related complications.
04.
During maternal cardiac arrest, perform necessary interventions like airway management and securing an IV (intravenous) line above the diaphragm. Provide 100% oxygen while avoiding excessive ventilation. If the patient is receiving IV magnesium, stop the infusion and immediately give calcium chloride or calcium gluconate to counter its effects.
05.
During maternal cardiac arrest, perform obstetric interventions by providing continuous lateral uterine displacement to relieve pressure on major blood vessels. Detach fetal monitors to focus on maternal resuscitation. If there’s no return of circulation within 4 minutes, prepare for a perimortem cesarean delivery to improve both maternal and fetal outcomes.
06.
Continue BLS/ACLS by performing high-quality CPR to maintain circulation. Use defibrillation if indicated to restore a normal heart rhythm. Administer other ACLS interventions, such as epinephrine, to improve blood flow and support the heart
07.
If the return of spontaneous circulation (ROSC) is not achieved within 5 minutes, consider performing an immediate perimortem cesarean delivery. This can improve the chances of survival for both the mother and the baby.
08.
Ensure the neonatal team (A group of healthcare professionals specialized in caring for newborns, especially premature babies) is ready to receive the neonate immediately after delivery to provide resuscitation and stabilization as needed.
Managing cardiac arrest in a pregnant woman is more complex than other cardiac arrest cases. In this case, there are two patients for the resuscitation teams, both the mother and the fetus require special consideration during this situation.
Optimal Patient Positioning and Left Uterine Displacement (LUD)
During cardiac arrest in pregnancy, the patient should be positioned on a firm (solid and stable) surface with continuous Left Uterine Displacement (LUD) to relieve pressure from the enlarged uterus on major blood vessels. This improves blood flow to the heart and brain, supporting effective resuscitation. Fig1, Fig2, and Fig3 will describe this position clearly.
Figure 1:
Image Source: Simulation and Medicine
Fig 1 shows a pregnant patient positioned with a slight tilt while receiving chest compressions from above. At the same time, Left Uterine Displacement (LUD) is performed by pushing the uterus to the left side. This helps reduce pressure on major blood vessels, improving blood flow to the heart and making resuscitation efforts more effective.
Figure 2:
Image Source: Simulation and Medicine
Fig 2 shows Left Uterine Displacement (LUD) being performed from the left side of the patient. In this technique, the healthcare provider gently pushes the pregnant uterus to the left to relieve pressure on the large blood vessels, helping to improve blood flow and support effective resuscitation.
Figure 3:
Image Source: Simulation and Medicine
Fig 3 shows Left Uterine Displacement (LUD) being done from the right side of the patient. The healthcare provider uses one or both hands to gently push the uterus to the left, reducing pressure on major blood vessels and improving circulation during resuscitation.
In summary, maternal Cardiac Arrest (MCA) is a rare but life-threatening emergency that can happen during pregnancy or in the first six weeks after delivery. Some of the main causes include severe bleeding, amniotic fluid embolism, and complications from pre-eclampsia. In these situations, the standard ACLS protocol needs to be adjusted to meet the unique needs of pregnant patients.
The best way to be ready for these emergencies is through regular training, reviewing the special considerations for maternal care, and participating in team-based code simulations. Keeping your ACLS certification up to date, especially with a focus on obstetric care, ensures you’re prepared when every second matters.
At Bayside CPR, we offer specialized ACLS course to help healthcare providers build the skills and confidence to manage these critical situations. Enroll today and be ready to make a difference when it counts most.
In an emergency, any trained physician should initiate PMCD within 4–5 minutes of maternal arrest without ROSC. It’s a resuscitative procedure prioritized for maternal benefit as well as fetal rescue.
Fetal monitoring is not prioritized during active resuscitation. The primary focus is maternal resuscitation. Fetal assessment resumes after maternal stabilization or during post-resuscitation care.
The most correct statement about cardiac arrest in pregnancy is that airway management and oxygenation should be prioritized during resuscitation for a pregnant patient.
