BLS in pregnancy refers to Basic Life Support tailored for pregnant individuals experiencing cardiac arrest, emphasizing simultaneous chest compressions, airway management, breathing support, and uterine displacement.
When a pregnant woman experiences cardiac arrest, the standard Basic Life Support (BLS) protocol is modified to address the unique physiological changes and considerations of pregnancy. The primary goal is to maintain maternal circulation and oxygenation while also maximizing the chances of fetal survival.
Key Components of BLS in Pregnancy
The C-A-B-U sequence highlights the critical steps:
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Chest Compressions: High-quality chest compressions are essential to circulate blood and oxygen. These should be performed at a rate of 100-120 compressions per minute and a depth of at least 2 inches, allowing for full chest recoil between compressions.
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Airway: Ensuring a patent airway is crucial. This may involve using techniques such as head-tilt/chin-lift or jaw-thrust maneuvers, keeping in mind the anatomical changes during pregnancy that can make airway management more challenging.
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Breathing: Provide rescue breaths with adequate tidal volume and rate. If possible, use supplemental oxygen.
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Uterine Displacement: Manual left uterine displacement (LUD) is performed to relieve aortocaval compression by the gravid uterus. This is typically done by placing a wedge or pillow under the woman’s right hip, tilting her approximately 15-30 degrees to the left. This maneuver helps to improve venous return and cardiac output, optimizing both maternal and fetal circulation. In the event of cardiac arrest during pregnancy, guidelines recommend manual left uterine displacement.
Why is BLS Different in Pregnancy?
Pregnancy induces several physiological changes that affect the response to cardiac arrest and resuscitation efforts:
- Increased Blood Volume: Pregnant women have a higher blood volume, but this can be offset by aortocaval compression, which reduces venous return.
- Increased Oxygen Consumption: Pregnant women consume more oxygen, making them more susceptible to hypoxemia during respiratory compromise.
- Airway Changes: Hormonal changes can lead to mucosal edema in the upper airway, increasing the risk of airway obstruction.
- Aortocaval Compression: The gravid uterus can compress the aorta and inferior vena cava when the woman is in a supine position, reducing blood flow to the heart and vital organs.
Example Scenario
Imagine a 30-week pregnant woman collapses and becomes unresponsive. Bystanders immediately call for emergency medical services (EMS) and initiate BLS:
- Chest Compressions: One rescuer starts chest compressions while another prepares to give rescue breaths.
- Airway: The rescuer opens the airway using the head-tilt/chin-lift maneuver.
- Breathing: Rescue breaths are administered.
- Uterine Displacement: Another rescuer places a wedge under the woman’s right hip to displace the uterus to the left, relieving pressure on the aorta and vena cava.
This coordinated approach, following the C-A-B-U sequence with uterine displacement, enhances the chances of successful resuscitation for both the mother and the fetus.
