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As a first responder, or paramedic, or even a doctor, one of the most difficult things you are going to deal with is a cardiac arrest. When we add to that, a cardiac arrest in a pregnant female, everything gets twice as complicated, and you start to really realize how stressful the situation can be. We are not only now dealing with the female herself, but we are dealing with family members, and we are dealing with an unborn child. The important things we have to recognize is, we still use defibrillators on pregnant females because at the end of the day, it is the female that we are dealing with or the mother first and without mother, the child is non-survivable, anyway.

So the resuscitation takes place in exactly the same way apart from a few slight changes. One of the most important changes is depending on how far down the trimesters that the female is, it depends on how large the child is and also it depends on actually the size and the weight and the effect that it has on the mother's aorta and circulatory supply. All pregnant females as they go through their trimesters, find it more difficult to lie flat on their back and most commonly will either prop themselves up on pillows or lie on their left or right side, most commonly the left side.

This is a natural reaction because the baby presses down on the main aorta going down the centre of the mother's chest, reducing blood flow to the brain, and making mom feel dizzy or lightheaded. If we turn the patient left lateral 30-45 degrees on her the left side, so her right side is up, the pressure and the weight of the child is relieved off the main central aorta, increasing blood flow to mom, to mom's brain, and keeping vital organs alive.

So the important thing is with the resuscitation on a pregnant female is we put her on a left lateral 30 to 40 degrees and pack underneath the back to keep them in that position. We then try and lift the child or lift the baby away from the centre of the mom to the right-hand side, again relieving pressure on the aorta. And CPR then commences on an angle between child and mother so as we can get a more efficient and effective compression of the heart, than we would whilst mom is on her back compressing the aorta and the child is in the way of the heart. So the compressions that we produce are far, far less effective.

Remember even good quality CPR is only about 30% efficient. So when we put into that a child and the size and shape and the compression of the aorta, that CPR becomes far less efficient. So it's important, left lateral, remove the weight of the child if we can off the centre of the chest, and then compress on a 45-degree angle between mother and baby on an angle.

Defibrillation pads are placed in the same position. Shocking is done the same, the whole CPR process is exactly the same for a normal adult male or female. However, the left lateral is the most important point. Remember mom, parents and everybody else will be very distressed during this process. So keeping calm, actually understanding what you are doing and acting slowly, but methodically, will be far more efficient.

The one thing that we will say is a cardiac arrest in pregnant females is a rare occurrence, but when it does happen, it is very traumatic for all parties, including yourself. And after, and post-resuscitation it's probably best to talk to somebody, to even possibly get counselling because it will be very stressful and very traumatic to the rescuer and the family.

  • IPOSi Unit two LO1.2, 1.3, 1.4, 2.1, 2.2 & 2.3