In this blog article, we will outline if it is safe to administer CPR and use an AED on a pregnant woman suffering from Maternal Cardiac Arrest. By the end of this article, you will know what you should and should not do when trying to save the life of a pregnant sudden cardiac arrest victim.

The short answer is that it is fine to use an automated external defibrillator (AED) and CPR on a pregnant woman. However, there are certain limitations to bear in mind, similar to any other healthcare situation such as if the mother has a high-risk pregnancy.

American Heart Association advises that administering chest compressions or using an AED to a female in cardiac arrest is not hazardous for the fetus since responders should not be concerned about injuring the fetus. When it comes to using an AED on a pregnant woman, one of the first concerns is whether or not it will harm the fetus. It is not hazardous for a pregnant woman to receive bystander CPR. In actuality, failing to provide these life-saving procedures lowers the survival rate for both the pregnant patient and her fetus.

What is Sudden Cardiac Arrest

Sudden cardiac arrest SCA is a condition in which the heart suddenly stops beating. SCA is usually caused by an abnormal heart rhythm, known as ventricular fibrillation. When this happens, blood flow to the brain and other vital organs quickly decreases, and death can occur within minutes if not treated immediately.

CPR and AED units can be used to treat SCA, but it is important to understand that there is a slightly higher risk of harm to the pregnant woman and her unborn child when these procedures are performed. However, the benefits of administering CPR on a pregnant woman and administering an AED far outweigh the risks, and every effort should be made to provide this lifesaving treatment to a pregnant woman in need.

Chain of Survival

The chain of survival is a concept used to describe the steps that need to be taken in order to improve the chances of survival for someone suffering from sudden cardiac arrest SCA. If a victim of SCA is pregnant, you still want to follow the chain of survival steps as followed:

• Early access to 911 or other emergency medical services
• Perform CPR Early (Start CPR Immediately)
• Early defibrillation with an AED

These three simple actions are also referred to as the Call-Push-Shock guide.

While the Call-Push-Shock technique suggests performing hands-only CPR on cardiac arrest victims, it is recommended that pregnant women receive traditional CPR with compressions and rescue breaths.

Rescue Breathes

The American Heart Association CPR training still recommends administering breaths when a first responder or emergency services personnel is going to perform CPR for maternal cardiac arrest victims. Although it is possible that the chest compressions may provide enough oxygen to the fetus, performing mouth-to-mouth resuscitation on a pregnant woman will help ensure that her unborn baby receives the oxygen it needs.

It is also worth noting that, while most AEDs have specific protocols for children, there is no difference in how you would use an AED on a pregnant woman versus a non-pregnant woman. The only exception to this rule is if the victim is overweight, as the pads may need to be placed in different locations.

Why do Pregnant Women Experience Cardiac Arrest?

There are a number of reasons why pregnant women may suffer from SCA that are not necessarily associated with being pregnant. One of the most common causes of SCA is an underlying heart condition that goes undetected. High blood pressure and diabetes are two other conditions that can lead to SCA.

In some cases, the cause of SCA in a pregnant woman may be related to her pregnancy. One condition that can cause SCA in pregnant women is called peripartum cardiomyopathy, which is a type of heart failure that occurs during the last month of pregnancy or up to five months postpartum. While the exact cause of peripartum cardiomyopathy is unknown, it is thought to be related to a change in hormone levels during pregnancy.

Other causes of SCA in pregnant women include:

Amniotic fluid embolism: This occurs when amniotic fluid enters the maternal bloodstream, which can lead to cardiovascular collapse.

Eclampsia: This is a condition that can occur during pregnancy or postpartum and is characterized by high blood pressure and protein in the urine. If left untreated, eclampsia can lead to seizures and coma.

Pulmonary embolism: This occurs when a blood clot blocks one of the pulmonary arteries, which can lead to SCA.

While the above conditions are more likely to cause SCA in pregnant women, it is important to remember that any underlying heart condition can lead to this life-threatening event. That is why it is so important for pregnant women to see their healthcare provider regularly and to report any unusual symptoms

In some cases, the cause of SCA in a pregnant woman may never be determined ahead of time. SCA by nature can happen to anyone at any time. Even the fittest athletes in the world have fallen victim to SCA such as Tottenham Hotspur and Danish midfielder Christian Eriksen, who was the victim of SCA during a game.

However, it is important to remember that, regardless of the cause, CPR and AEDs can be used to save the lives of both the pregnant patient and her unborn child.

CPR and an Automated External Defibrillator are two of the most important tools in the chain of survival for SCA victims.

Common Maternity Cardiac Arrest Causes

Three common categories regarding the common causes of cardiac arrest in pregnant women are the following:

• Non-obstetric – Pulmonary embolism, sepsis, preexisting cardiac condition, and stroke are all non-obstetric causes of cardiac arrest in pregnant women.
• Obstetric – Amniotic fluid embolism, uterine rupture, and postpartum hemorrhage are all obstetric causes of cardiac arrest in pregnant women.
• Iatrogenic – Iatrogenic causes of cardiac arrest in pregnant women include anesthesia-related, medication-related, and procedure-related.

Pregnant women have an increased risk of suffering from a number of non-obstetric causes of SCA. These include pulmonary embolism, sepsis, preexisting cardiac conditions, and

Where do you put a defibrillator on a pregnant woman?

The American Heart Association 2020 guidelines recommend that, when using an AED on a pregnant woman, the pads should be placed in the following locations:

Anterior-lateral position: one pad on the lower right side of the patient’s rib cage and one pad on the upper left side of her abdomen, just below the breast.

AHA Algorithm for Advanced Maternal Resuscitation

The American Heart Association (AHA) has created a sophisticated resuscitation algorithm for pregnant women who have experienced SCA. The following are the stages in this procedure:

Call 911 or other emergency medical services immediately with maternal “code blue”

Begin CPR with 30 chest compressions and 2 breaths

One person should be in charge of her airway (using a bag valve mask and intubating)

Someone should apply manual left uterine displacement to assist in ensuring optimal blood flow to the heart.

• One-Handed Technique – With the responder standing on the woman’s right side and her patient flat on her back, the responder pushes her uterus away (toward the patient’s left side).

• Two-Handed Technique – With the patient on her back, the responder stands on the left side of the woman and uses two hands to draw her uterus.

The 2020 American Heart Association CPR and ECC Guidelines recommend the following procedure for expert maternal resuscitation by ACLS professionals in the hospital. The American Heart Association’s 2020 AHA Recommendations and procedures for in-hospital maternal cardiac arrest include the following:

Rescue breaths are still recommended for pregnant SCA victims. Although it is possible that the chest compressions may provide enough oxygen to the fetus, performing mouth-to-mouth resuscitation on a pregnant woman will help ensure that her baby receives the oxygen it needs.

It is also worth noting that, while most AEDs have specific protocols for children, there is no difference in how you would use an AED on a pregnant woman versus a non-pregnant woman. The only exception to this rule is if the victim is overweight, as the pads may need to be placed in different locations.

In Summary

It is safe to use an AED on a pregnant woman. While you may never have to administer CPR to improve blood flow or use an AED on a pregnant woman, don’t hesitate to give the same life-saving skills that you would to someone who isn’t pregnant if the need arises.