Cardiac Arrest with Pregnancy

Question 1

At the gestational age of ____ weeks and beyond the pregnant uterus can press against the _____ _____ _____ impeding venous return and cardiac output.

Answer 1

20 weeks

inferior vena cava

Question 2

Compression of the inferior vena cava can be relieved by:

Answer 2

pulling the gravid uterus to the left or tilting the patient approximately 15 to 30 degrees to the left.

Question 3

Chest compressions should be performed where on a pregnant patient? Why?

Answer 3

Higher on the sternum slightly above center of the sternum. This adjusts for the elevation of the diaphragm and abdominal organs caused by the gravid uterus.

Question 4

Discuss the usage of vasopressor agents like epinephrine, vasopressin, and dopamine in cardiac arrest of the pregnant patient.

Answer 4

These agents will cause decreased blood flow to the uterus but there are no alternatives so regular doses must be administered. The fetus’s best chance for survival is the mother’s survival.

Question 5

Why is securing an advanced airway early in resuscitation of these patients neccessary?

Answer 5

Due to hormonal changes the sufficiency of the gastro-esophageal sphincter decreases which increases the risk of regurgitation and aspiration.

Question 6

What changes to your choice of ET tube sizes should you make for the pregnant patient and why?

Answer 6

You should use a tube 0.5 to 1 mm smaller in diameter than used for a non pregnant female of similar size due to narrowing of the airway from edema.

Question 7

Why may ventilation volumes need to be decreased in these patients?

Answer 7

Because the diaphragm is elevated which keeps the lungs from expanding as far.

Question 8

Why can pregnant patients develop hypoxemia rapidly?

Answer 8

They have a decreased functional residual capacity and an increased oxygen demand.

Question 9

What pregnancy related diseases should the provider be familiar with?

Answer 9

hypermagnesemia, ACS, pre eclampsia, eclampsia, HELLPS, aortic dissection, PE, stroke, amniotic fluid embolus, trauma, drug overdose.

Question 10

What features of the cardiac arrest provide the greatest increase for the infant’s survival? (5)

Answer 10

1) short interval between mother’s arrest and delivery
2) non sustained pre arrest hypoxia sustained by mother
3) minimal to no signs of fetal distress before mother’s cardiac arrest
4) aggressive and effective resuscitative efforts for the mother
5) c-section performed in medical center with a NICU