Various factors have been proposed as causing cardiac arrest in pregnancy, e.g. perinatal changes in physiology of the mother. The gravid uterus may cause compression of the inferior vena cava resulting in decreased circulation. The net result of the decline in venous return is hypotension, which may lead to shock.
An unexpected cardiovascular event or catastrophe should always prompt the rescue of the unborn infant. Emergency cesarean section, which may immediately increase the chance of survival of both mother and child, should be considered. The aim of this dramatic procedure is to save the lives of the mother and the fetus while still neurologically intact. Cesarean section may benefit the mother, even if the chance of fetal resuscitation and survival is lower.
The response to cardiopulmonary arrest in a pregnant woman depends on the age of the infant, if it is before or after the age of likely survival if delivered. The critical threshold of viability is generally accepted as 24-26 weeks, depending on available neonatal intensive care capabilities. In cardiac arrest occuring before the 24th week, one should not modify CPR protocols and should direct all efforts to saving the mother.
Advanced Cardiac Life Support protocols should be adhered to in the management of cardiac arrest in pregnancy. No differences are suggested regarding standard Advanced Cardiac Life Support and ABCD protocols for the airway, circulation and defibrillation. Chest compressions however, should be performed using a modified technique in the term pregnant woman in the supine position.
Keywords: Pregnancy, cardiopulmonary arrest, cesarean, emergency department