1. Cardiopulmonary Resuscitation: Considerations in third trimester of pregnancy
Promoting multiprofessional education and development in Scottish maternity care

2. Cardiopulmonary Resuscitation
BLS (Basic Life Support)
ALS (Advanced Life Support)
Role of caesarean section in cardiopulmonary resuscitation in late pregnancy.

3. Cardiopulmonary Resuscitation
Physiological changes of pregnancy
Adaptations of CPR in pregnancy
Indications for peri-arrest caesarean section.

4. Ensure pregnant patient is placed in a lateral tilt

5. Ensure pregnant patient is placed in a lateral tilt

7. SHOCKABLE
Ventricular Fibrillation
Ventricular Tachycardia

8. PEA - Complete Heart Block PEA narrow complex Tachycardia
Non-Shockable
NON SHOCKABLE
Asystole
NON SHOCKABLE
PEA - Complete Heart Block
NON SHOCKABLE
PEA narrow complex Tachycardia

9. Causes of Cardiac Arrest
4 Hs Ts
Hypoxia Thromboembolism
Hypovolaemia Toxic (? Magnesium Sulphate)
Hypo/hyperkalaemia Tamponade
Hypothermia Tension pneumothorax
and also
ECLAMPSIA
LA is local anaesthetic

10. CPR with Adaptations
WHY?

11. Because … Physiological changes of pregnancy
Aorto-caval compression by gravid uterus impedes venous return and reduces cardiac output.
Increased risk of aspiration of stomach contents.
More likely to be difficult to intubate.
Lower gastric pH- chemical pneumonitis more likely than in the non-pregnant.

12. How is CPR adapted?

13. CPR Adaptations Tilt patient to the left or manually displace uterus.
Apply cricoid pressure and intubate early.
Involve senior appropriate member of staff immediately or as early as possible.

15. Caesarean section in maternal resuscitation in late pregnancy
Part of the resuscitation technique.
Decision by four minutes of unsuccessful CPR
Performed by FIVE minutes if CPR is unsuccessful.
Makes CPR more efficient.

16. CPR Post Caesarean Section
Increases venous return
Improves ease of ventilation
CPR can be carried out in the supine position
Decreased oxygen requirement after delivery.

17. Caesarean section in maternal resuscitation in late pregnancy
Continue maternal CPR throughout
Incision
Equipment (scalpel, artery forceps)
Potentially good fetal outcome if delivery occurs by 5 minutes of cardiac arrest.

18. Other Considerations
Effective spinal or epidural will make chest compression LESS effective: larger doses of epinephrine may be required.
If cardiac arrest is due to intravenous bupivacaine, prolonged CPR will be required.

19. Any Questions?

20. Summary Differences in CPR in pregnant and non-pregnant patients.
Strategies used to overcome these physiological differences.
Caesarean section is part of maternal resuscitation in late pregnancy.