Guideline Summary

Cardio-respiratory arrest in pregnancy is very rarely due to a primary cardiac cause; common causes include pulmonary or amniotic fluid embolus. Effective resuscitation of the mother will provide effective resuscitation of the fetus. There are a number of physiological and anatomical changes during pregnancy that may influence the management of the pregnant patient during resuscitation including:
-cardiac output increases by 20-30% in the first 10 weeks of pregnancy
-the average maternal heart rate increases by 10-15 beats per minute
-both systolic and diastolic blood pressure fall, on average by 10-15mmHg
-as the fetus enlarges the diaphragm becomes splinted. Breathing effort and rate increase and vital capacity is decreased
-both blood volume (45% increase) and numbers of red cells increase, but not in proportion, so the patient becomes relatively anaemic
-due to the increase in blood volume the pregnant patient is able to tolerate greater blood or plasma loss before showing signs of hypovolaemia. This compensation is at the expense of shunting blood away from the uterus and placenta and therefore fetus.

This guideline provides guidance for paramedics¹ for the assessment and management of the effects of pregnancy on maternal resuscitation.

¹The principles will be applicable to all pre-hospital clinicians.

Current guideline - issued 2006