Is BLS different on a pregnant woman?
blog post contributed by Robb D., BLS Instructor at CPR Seattle
BLS is my favorite class to teach, because it covers a lot of different situations that a healthcare professional may encounter during sudden cardiac arrest.
About halfway through a BLS class, we come to the “Special Considerations” section which touches on some of these situations, including:
- Rescue Breaths
- CPR with an Advanced Airway and
- BLS on a Pregnant Woman (Maternal CPR)
Questions on maternal CPR come up every class session. While CPR for a pregnant person is mostly the same as normal adult resuscitation, some concerns are unique in this situation. For maternal CPR, there are two patients - the parent and the fetus. Simply put, what is best for the parent is also best for the baby. However, let's dive deeper into the five most common questions students ask about giving CPR to a pregnant person:
How does pregnancy change physiology with regards to CPR?
A pregnant person is especially vulnerable to oxygen deprivation during cardiac arrest, as the fetus needs substantial levels of oxygen. This means a 20%+ increase in oxygen consumption2 and a 40% increase in cardiovascular metabolism to adequately supply the fetus. For this reason, the responding healthcare team is urged to place the most experienced provider in charge of airway management, which should always be considered more difficult in a pregnant patient.
Hormones affected during pregnancy can also impede respiration by narrowing air passages, which worsens the hazards of maternal cardiac arrest. When a pregnant patient suffers from sudden cardiac arrest, immediate high-quality CPR and AED use are critical.
Women are 27% less likely than men to receive bystander CPR1. This suggests that pregnant women likely receive bystander CPR even less because responders are credibly concerned about causing injury to both the mother and the child.
How do I give CPR to a pregnant person?
While advanced life support professionals responding to maternal cardiac arrest must simultaneously perform maternal and obstetric treatments, BLS providers are directed to modify CPR by shifting a rounded abdomen to the victim’s left side (manual left uterine displacement, or LUD). This is done to relieve the pressure of the enlarged uterus on the abdominal aorta (the artery carrying outgoing blood to the lower body) and the inferior vena cava (the large vein that carries blood from the torso and lower body back to the right side of the heart). The efficiency of chest compressions is improved when this pressure is minimized.
Do we put our hands in the same place for chest compressions?
Yes; this part of CPR is no different. Hands are placed over the lower half of the sternum, just as with CPR for any other adult. Compressions are given to a depth of at least two inches, at the rate of 100-120 per minute.
Do we still use the adult pads with the AED?
AED use is also the same as with any adult victim - no modification of the application of electrode pads or of electric shock is recommended. A manual defibrillator is preferred for this situation, but an AED may be used if that is the only option.
Won’t CPR hurt the baby?
Not at all. The fetus will likely not survive if the parent does not receive CPR and defibrillation as quickly as possible.
BLS Procedures for a Pregnant Victim
A minimum of 4 BLS providers is recommended by the AHA for this situation2.
Here is the cardiac arrest in pregnancy in-hospital BLS algorithm:
And as with any CPR, advanced providers should be used as soon as possible. Advanced providers may direct BLS providers to assist with the resuscitation attempt, as outline in the “High Performance Teams” section of the BLS provider course.
If you are a lay rescuer, don’t worry about any of this and don’t hesitate to do CPR on a pregnant person (which is the directive discussed during the AHA Heartsaver Adult CPR class, which I also teach).
To sign up for a BLS class at CPR Seattle, please visit our website here.
1 Blewer AL, McGovern SK, Schmicker RH, May S, Morrison LJ, Aufderheide TP, Daya M, Idris AH, Callaway CW, Kudenchuk PJ, Vilke GM, Abella BS; Resuscitation Outcomes Consortium (ROC) Investigators. Gender Disparities Among Adult Recipients of Bystander Cardiopulmonary Resuscitation in the Public. Circ Cardiovasc Qual Outcomes. 2018 Aug;11(8):e004710. doi: 10.1161/CIRCOUTCOMES.118.004710. PMID: 30354377; PMCID: PMC6209113.
2 Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association 6 Oct 2015 https://doi.org/10.1161/CIR.0000000000000300Circulation. 2015;132:1747–1773
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Published on April 2, 2022