Synopsis
Distinguish collapse from cardiac arrest, deliver effective maternal resuscitation with pregnancy adaptations, and apply current principles for timely resuscitative birth.
- Use standard high-quality adult BLS and ALS, with pregnancy-specific modifications.
- Keep the woman supine for effective compressions and use manual left uterine displacement above twenty weeks.
- Give indicated shocks promptly at standard adult energies; pregnancy is not a reason to withhold defibrillation.
- Investigate the usual four Hs and four Ts alongside pregnancy-specific causes.
- RCUK 2025 recommends early preparation and resuscitative hysterotomy as soon as possible by a skilled team at the arrest site.
- Do not transfer a woman in ongoing arrest to theatre simply to perform resuscitative hysterotomy.
- Emptying the uterus is a maternal resuscitation intervention, not contingent on proving fetal viability.
- Continue multidisciplinary post-arrest care and investigate the cause after circulation returns.
Key red flags
Unresponsiveness with absent or abnormal breathing requires immediate recognition of cardiac arrest; gasping is not normal breathing.
Severe breathlessness, chest pain, seizure, major bleeding or rapidly worsening circulation can precede arrest.
A pregnant woman can arrest outside maternity services; the emergency response must bring appropriate skills and equipment to her.
Investigation priorities
Identify shockable or non-shockable arrest and guide immediate ALS.
Management branches
A pregnant or recently postpartum woman is unresponsive and not breathing normally.
- Call the hospital cardiac-arrest team or emergency services and request obstetric, anaesthetic and neonatal support; bring the resuscitation trolley and birth equipment.
- Start chest compressions at 100–120 per minute, depth 5–6 cm with full recoil, on a firm surface and with minimal interruption.
- Use thirty compressions to two breaths until an effective advanced airway permits continuous compressions with appropriate ventilation.
- Apply defibrillator pads, analyse the rhythm and deliver indicated shocks using the standard adult approach; resume compressions immediately afterwards.
- Above twenty weeks, assign an assistant to maintain manual left uterine displacement while the woman remains supine for effective CPR.
Key medicines
Adrenaline during standard adult cardiac arrestGive 1 mg intravenously or intraosseously as soon as possible in a non-shockable arrest, or after the third shock in a shockable arrest; repeat every 3–5 minutes while ALS continues.Use the correct arrest preparation and stop arrest dosing when circulation returns. This is not the dose for anaphylaxis with a pulse; specific toxicological arrests and highly monitored physiology-guided resuscitation may require modified expert protocols.
Amiodarone for refractory VF or pulseless VTGive 300 mg intravenously after three shocks for persistent or recurrent VF or pulseless VT; give a further 150 mg after five shocks.Do not delay shocks or compressions to administer it. This bolus schedule is for cardiac arrest and differs from slower infusion treatment of a patient with a pulse.