Advanced Life Support Obstetric Concepts

Core Resuscitation Modifications for Pregnancy

Manual left lateral uterine displacement must be maintained throughout all resuscitation efforts in pregnant patients at ≥20 weeks gestation or when fundal height reaches the umbilicus, as recommended by the American Heart Association 1, 2, 3
Oxygenation and airway management take precedence over other interventions because pregnant patients have increased metabolic demands and decreased functional reserve capacity, making them profoundly susceptible to rapid hypoxia, according to the American College of Cardiology 1, 2, 3, 5
The most experienced provider available should manage the airway, as difficult airways are common in pregnancy, and options include endotracheal intubation or supraglottic airway devices, as suggested by the American Society of Anesthesiologists 4, 5, 6

If return of spontaneous circulation (ROSC) is not achieved within 4 minutes of maternal cardiac arrest, begin hysterotomy immediately, as recommended by the American Heart Association 6, 7
The goal is to complete delivery within 5 minutes of arrest onset to optimize both maternal and fetal outcomes, with maternal survival reported up to 39 minutes after arrest, according to the American College of Cardiology 1, 2, 3, 5
Neonatal survival is dramatically better when PMCD occurs within 5 minutes, with 24/25 infants surviving versus 7/10 when performed after 5 minutes, as noted by the American Academy of Pediatrics 4, 5

Basic and advanced life-support equipment must be immediately available in the operative area of all labor and delivery units, including pulse oximeter, qualitative carbon dioxide detector, and standard airway management tools, as recommended by the American Society of Anesthesiologists 6, 9
Team planning for maternal cardiac arrest must involve obstetric, neonatal, emergency, anesthesiology, intensive care, and cardiac arrest services, according to the American Heart Association 3, 4, 5

Do not perform fetal monitoring during maternal cardiac arrest as it interferes with maternal resuscitation efforts, as recommended by the American College of Cardiology 1, 2, 3
Targeted temperature management is recommended for pregnant women who remain comatose after ROSC, with continuous monitoring of the fetus for bradycardia and obstetric and neonatal consultation, according to the American Heart Association 1, 2, 3