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The critically ill pregnant patient who arrests requires positioning in the left lateral position, 100% oxygen supplementation, intravenous access and fluid bolus, and consideration of reversible causes of cardiac arrest and identification of preexisting medical conditions that may complicate resuscitation (Jeejeebhoy et al., 2015).

• Because the hormonal changes associated with pregnancy alter the gastroesophageal sphincter, the patient is at increased risk of regurgitation and aspiration. Continuous cricoid pressure during positive pressure ventilation is recommended for any unconscious pregnant woman. Chest compressions are performed higher on the sternum to adjust for the gravid uterus elevation of the diaphragm and abdominal contents. Standard defibrillation doses are used; no evidence exists that defibrillator shocks affect the fetal heart adversely. Fetal or uterine monitors should be removed before defibrillation. Immediate evacuation of the uterus may also be required to improve resuscitative efforts for the mother.

Table 29-1describes modifications of advanced cardiac life support (ACLS) for the pregnant patient.