Manual displacement of the gravid uterus to the left. What?! Who’s been in emergency medicine since dirt and never heard that terminology? The technique has been around for centuries but has recently been brought to the forefront with the new 2015 AHA guidelines for resuscitation. Contact our office for a full PDF of the AHA Guidelines Highlights (see excerpt below page 20)
Cardiac Arrest in Pregnancy: Provision of CPR
Priorities for the pregnant woman in cardiac arrest are provision of high-quality CPR and relief of aortocaval compression. If the fundus height is at or above the level of the umbilicus, manual left uterine displacement can be beneficial in relieving aortocaval compression during chest compressions.
Shocking NewsTo relieve aortocaval compression during chest compressions and optimize the quality of CPR, it is reasonable to perform manual left uterine displacement in the supine position first. If this technique is unsuccessful, and an appropriate wedge is readily available, then providers may consider placing the patient in a left lateral tilt of 27° to 30°, using a firm wedge to support the pelvis and thorax.
Recognition of the critical importance of high- quality CPR and the incompatibility of the lateral tilt with high-quality CPR has prompted the elimination of the recommendation for using the lateral tilt and the strengthening of the recommendation for lateral uterine displacement.
Cardiac Arrest in Pregnancy: Emergency Cesarean Delivery
In sitituations such as nonsurvivable maternal trauma or prolonged maternal pulselessness, in which maternal resuscitative efforts are obviously futile, there is no reason to delay performing perimortem cesarean delivery (PMCD). PMCD should be considered at 4 minutes after onset of maternal cardiac arrest or resuscitative efforts (for the unwitnessed arrest) if there is no maternal ROSC. The clinical decision to perform a PMCD— and its timing with respect to maternal cardiac arrest—is complex because of the variability in level of practitioner and team training, patient factors (eg, etiology of arrest, gestational age of the fetus), and system resources.
Emergency cesarean delivery may be considered at 4 minutes after onset of maternal cardiac arrest if there is no ROSC.
Why: PMCD provides the opportunity for separate resuscitation of the potentially viable fetus and the ultimate relief of aortocaval compression, which may improve maternal resuscitation outcomes. The clinical scenario and circumstances of the arrest should inform the ultimate decision around the timing of emergency cesarean delivery.
Additional important information for resuscitation the pregnant patient include: