Chapter 12 - Acute collapse and resuscitation

Summary

Maternal collapse includes a variety of acute life threatening events involving maternal cardiorespiratory or central nervous systems. Maternal resuscitation follows standard Advanced Cardiac Life Support (ACLS) guidelines with a limited number of pregnancy-specific alterations. The primary variation from non-pregnancy guidelines is the requirement to displace the gravid uterus laterally to increase cardiac output. Cardiac output during closed chest massage in cardiopulmonary resuscitation (CPR) is approximately 30% of normal. Traditionally, displacement of the gravid uterus has been done by maternal tilt from 15° to 30° to facilitate increased venous return and cardiac output. Immediate awareness of the need to perform perimortem cesarean delivery 4 minutes after persistent cardiopulmonary arrest and the availability of an emergency kit for surgery can result in faster delivery of the baby, faster return of the maternal circulation, and better clinical outcomes for both mother and child.