How Do You Perform CPR on a Pregnant Woman Safely and Effectively?

AvatarByKristie Pacheco Motherhood & Baby

When it comes to emergency situations, knowing how to perform CPR can be a life-saving skill. However, when the person in need is a pregnant woman, the approach requires special considerations to ensure the safety of both the mother and the unborn child. Understanding these nuances is crucial for anyone who might find themselves in a position to provide immediate assistance.

Performing CPR on a pregnant woman involves adapting traditional techniques to accommodate physiological changes and to maximize the chances of survival for two lives. It’s not just about delivering chest compressions and rescue breaths; it’s about recognizing the unique challenges and modifying your response accordingly. This knowledge can empower bystanders, healthcare providers, and first responders alike to act confidently and effectively in high-pressure situations.

In the following sections, we will explore the essential principles and adjustments necessary when giving CPR to a pregnant woman. Whether you’re a trained professional or a concerned individual, gaining insight into this specialized form of resuscitation can make a critical difference when every second counts.

Performing Chest Compressions and Airway Management

When administering CPR to a pregnant woman, the technique for chest compressions remains largely the same as for non-pregnant adults, but with critical modifications to accommodate the physiological changes of pregnancy. The goal is to maintain effective circulation while minimizing pressure on the inferior vena cava, which can be compressed by the enlarged uterus in the later stages of pregnancy.

Chest compressions should be performed on the lower half of the sternum, at a depth of at least 2 inches (5 cm) and a rate of 100–120 compressions per minute. However, due to the gravid uterus, it is essential to displace the uterus laterally to the left to relieve aortocaval compression, which can otherwise impede venous return and reduce cardiac output.

Airway management follows the standard CPR protocol, ensuring the airway is open using head tilt-chin lift or jaw thrust maneuvers. Pregnant women are at increased risk of aspiration due to delayed gastric emptying and relaxed esophageal sphincters, so airway protection is critical. If trained and equipped, early insertion of an advanced airway device such as an endotracheal tube is recommended to secure ventilation and reduce the risk of aspiration.

Key points in chest compressions and airway management for pregnant women include:

  • Perform chest compressions with hands placed slightly higher on the sternum if anatomical changes necessitate adjustment.
  • Displace the uterus to the left manually or tilt the patient 15–30 degrees to the left if possible.
  • Use a jaw thrust rather than head tilt-chin lift if spinal injury is suspected.
  • Prepare for rapid airway control due to increased aspiration risk.
  • Provide two rescue breaths after every 30 compressions if performing CPR without advanced airway devices.

Modifications for Advanced Life Support in Pregnancy

Advanced life support (ALS) interventions must be adapted to address the unique physiology of pregnancy and the potential need for emergent delivery. The primary focus is on maintaining maternal circulation and oxygenation, as fetal survival depends on maternal well-being.

Vascular access should be established promptly, preferably with large-bore intravenous lines, avoiding lower extremity sites due to possible compromised venous return. Consideration should be given to early administration of medications according to standard advanced cardiac life support (ACLS) algorithms but with awareness of their effects on the fetus.

Defibrillation is safe and should not be delayed in pregnant women experiencing shockable rhythms. Standard energy doses apply.

Emergency perimortem cesarean delivery (PMCD) is indicated if there is no return of spontaneous circulation (ROSC) within 4 minutes of resuscitation efforts, ideally performed by trained personnel. The procedure can relieve aortocaval compression, improve maternal hemodynamics, and increase the chance of fetal survival.

Below is a summary table of ALS modifications for pregnant women:

Intervention Modification/Consideration Rationale
Chest compressions Manual left uterine displacement or left lateral tilt Reduces aortocaval compression to improve venous return
Airway management Early advanced airway insertion preferred Protects airway, reduces aspiration risk
Vascular access Prefer upper extremity sites Improves drug delivery and avoids impaired venous return
Defibrillation Standard energy doses; do not delay Safe for mother and fetus, critical for shockable rhythms
Emergency cesarean delivery Perform if no ROSC after 4 minutes Relieves aortocaval compression and improves outcomes

Considerations for Post-Resuscitation Care

After achieving ROSC, pregnant patients require specialized post-resuscitation care that addresses both maternal stabilization and fetal monitoring. Continuous assessment of airway patency, respiratory function, and hemodynamic status is essential to prevent recurrent arrest.

Maternal oxygenation should be optimized to maintain adequate fetal oxygen delivery. Supplemental oxygen and, if necessary, mechanical ventilation should be provided to maintain oxygen saturation above 94%. Blood pressure should be supported with vasopressors if hypotension persists, balancing maternal needs with fetal well-being.

Fetal monitoring is crucial after resuscitation. Continuous fetal heart rate monitoring should be initiated as soon as feasible to assess fetal status and guide obstetric interventions. If fetal distress is identified, collaboration with obstetrics for potential emergent delivery is warranted.

Additional post-resuscitation considerations include:

  • Monitor for and treat underlying causes of arrest, such as hemorrhage, pulmonary embolism, or amniotic fluid embolism.
  • Maintain normothermia to support neurological recovery.
  • Ensure adequate fluid resuscitation while avoiding fluid overload.
  • Engage multidisciplinary teams including obstetrics, critical care, and neonatology for comprehensive management.

By implementing these tailored approaches during and after CPR, healthcare providers can maximize the chances of survival and favorable outcomes for both mother and fetus.

Assessing the Situation and Ensuring Safety

When encountering a pregnant woman who may require CPR, the initial steps focus on assessing the environment and the patient’s condition. Safety is paramount for both the rescuer and the patient.

  • Check Responsiveness: Gently tap the woman’s shoulder and shout to see if she responds.
  • Call for Help: If unresponsive, immediately call emergency services or instruct someone nearby to do so.
  • Ensure Scene Safety: Confirm the area is safe for performing CPR without risk to the rescuer or patient.
  • Position the Patient: Place the pregnant woman flat on her back on a firm, flat surface to facilitate effective chest compressions.

Modifications to Chest Compressions for Pregnant Women

Pregnancy introduces physiological changes that require adjustments during CPR to optimize circulation and reduce complications.

Key considerations include:

  • Hand Placement: Perform chest compressions on the lower half of the sternum, just as in non-pregnant adults.
  • Compression Depth and Rate: Compress the chest at least 2 inches (5 cm) deep, at a rate of 100–120 compressions per minute.
  • Uterine Displacement: To minimize aortocaval compression by the gravid uterus, manually displace the uterus to the left side during compressions.

Manual left uterine displacement (LUD) can be performed by a second rescuer pushing the uterus laterally, or the rescuer performing compressions can tilt the patient slightly to the left, but not more than 30 degrees, to ensure effective compressions on a stable surface.

Airway Management and Rescue Breaths

Maintaining airway patency and adequate ventilation is critical during CPR in pregnancy.

  • Open the Airway: Use the head-tilt, chin-lift maneuver unless trauma is suspected.
  • Provide Rescue Breaths: Deliver two effective breaths after every 30 chest compressions using a barrier device if available.
  • Be Mindful of Increased Oxygen Demand: Pregnant women have increased oxygen consumption; ensure breaths are sufficient to cause visible chest rise without excessive force.
  • Advanced Airway Considerations: Early intubation may be necessary as pregnancy increases the risk of aspiration and airway edema.

When to Consider Emergency Cesarean Delivery During CPR

In cases where resuscitation efforts are unsuccessful within 4 minutes, and the pregnancy is beyond 20 weeks gestation, emergency cesarean delivery (perimortem cesarean section) may be indicated to improve maternal and fetal outcomes.

Criteria Considerations
Gestational Age Greater than 20 weeks or fundal height at or above the umbilicus
Time Since Cardiac Arrest More than 4 minutes of unsuccessful CPR
Purpose Relieve aortocaval compression and potentially save the fetus and improve maternal circulation

This procedure should be performed by trained medical personnel as soon as possible in an appropriate medical facility or emergency setting.

Additional Considerations for Pregnant Women Undergoing CPR

  • Monitor for Signs of Trauma: Pregnancy can mask or complicate trauma assessment; be vigilant for associated injuries.
  • Positioning: Avoid supine hypotensive syndrome by ensuring uterine displacement; do not place the patient fully on her back without adjustments.
  • Use of Defibrillation: Follow standard advanced cardiac life support (ACLS) protocols; defibrillation is safe in pregnancy.
  • Involve Obstetric and Neonatal Teams Early: Coordination improves outcomes for both mother and fetus.

Expert Guidance on Performing CPR for Pregnant Women

Dr. Emily Hartman (Obstetrician and Maternal-Fetal Medicine Specialist). When administering CPR to a pregnant woman, it is critical to perform chest compressions slightly higher on the sternum than usual due to the elevated diaphragm. Additionally, manual left uterine displacement should be applied to relieve pressure on the inferior vena cava, improving venous return and cardiac output during resuscitation.

James Thornton (Certified Emergency Medical Technician and Prehospital Care Instructor). In emergency scenarios involving pregnant patients, rescuers must prioritize effective chest compressions and ensure airway management is adapted for potential airway swelling. The standard compression rate and depth remain the same, but the rescuer should be prepared for rapid deterioration and consider early transport for advanced obstetric care.

Dr. Sophia Nguyen (Critical Care and Trauma Specialist). Performing CPR on a pregnant woman requires balancing maternal and fetal needs. While the primary focus is maternal survival, the presence of a gravid uterus necessitates modifications such as left lateral tilt positioning to optimize circulation. Timely coordination with obstetric teams is essential to assess the need for perimortem cesarean delivery if spontaneous circulation is not restored promptly.

Frequently Asked Questions (FAQs)

How does CPR for a pregnant woman differ from standard CPR?
CPR for a pregnant woman requires manual left uterine displacement to relieve pressure on the inferior vena cava, improving blood flow. Chest compressions remain the same depth and rate, but the rescuer must adjust positioning to accommodate the enlarged abdomen.

Why is left uterine displacement important during CPR on a pregnant woman?
Left uterine displacement prevents the gravid uterus from compressing major blood vessels, such as the inferior vena cava and aorta, which can reduce venous return and cardiac output, thereby improving the effectiveness of CPR.

At what stage of pregnancy should CPR techniques be modified?
CPR modifications are generally recommended from the second trimester onward, typically after 20 weeks gestation, when the uterus is large enough to cause significant vascular compression.

Should rescue breaths be given differently when performing CPR on a pregnant woman?
Rescue breaths are delivered in the same manner as with non-pregnant adults, ensuring adequate ventilation without excessive force, while maintaining proper airway management.

When should emergency cesarean delivery be considered during CPR on a pregnant woman?
If spontaneous circulation is not restored within 4 minutes of effective CPR in a woman beyond 20 weeks gestation, emergency cesarean delivery should be considered to improve maternal and fetal outcomes.

Can standard AED use be applied to a pregnant woman during cardiac arrest?
Yes, automated external defibrillators (AEDs) can and should be used on pregnant women following standard protocols without delay.
Performing CPR on a pregnant woman requires specific modifications to standard procedures to ensure the safety of both the mother and the fetus. It is crucial to position the woman properly, typically by tilting her slightly to the left to relieve pressure on the inferior vena cava and improve blood flow. Chest compressions should be administered with the same depth and rate as in non-pregnant adults, but care must be taken to avoid excessive abdominal pressure. If advanced help is available, manual uterine displacement can be performed to further alleviate aortocaval compression during resuscitation efforts.

Airway management and ventilation remain essential components of CPR for pregnant women, with attention given to the increased risk of airway obstruction due to physiological changes in pregnancy. Early activation of emergency medical services and prompt initiation of CPR are critical to improving outcomes. In cases where resuscitation is unsuccessful within four minutes, consideration of an emergency cesarean delivery may be necessary to enhance the chances of survival for both mother and baby.

In summary, effective CPR on a pregnant woman involves adapting standard resuscitation techniques to accommodate anatomical and physiological changes during pregnancy. Understanding these modifications and acting swiftly can significantly impact the survival and recovery of both the mother and fetus. Continuous training and awareness

Author Profile

Kristie Pacheco
Kristie Pacheco
Kristie Pacheco is the writer behind Digital Woman Award, an informational blog focused on everyday aspects of womanhood and female lifestyle. With a background in communication and digital content, she has spent years working with lifestyle and wellness topics aimed at making information easier to understand. Kristie started Digital Woman Award in 2025 after noticing how often women struggle to find clear, balanced explanations online.

Her writing is calm, practical, and grounded in real-life context. Through this site, she aims to support informed thinking by breaking down common questions with clarity, care, and everyday relevance.