Maternal Resuscitation

ABC & CPR

Learning outcomes
• To understand the Primary Survey (ABCD)

• To assess and treat based on this sequence

• To understand the importance of maternal resuscitation

• To be able to be able to competently perform adult Cardio-

Pulmonary Resuscitation

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DR ABC
• D – Danger

• R – Response

• A – Airway

• B – Breathing

• C – Circulation

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Steps to resuscitation
Danger

Response

Yes No

Assess for other Open Airway

complications
Check Breathing and Circulation

Yes No

Monitor closely CPR 30:2 Get Resus

equipment

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Danger
Approach to an apparently lifeless or critically ill
patient

• Is it safe to approach?

• Ensure you are not putting yourself or the patient

at further risk!

• You can’t help anyone else if you are hurt

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Response
• Quickly Shake and SHOUT Name:

• Hello, Mrs Tilt, are you ok?’

• If unresponsive: SHOUT FOR HELP

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 Compression of Vena Cava

• Pregnant uterus compresses vena cava

causing BP to drop

Unresponsive pregnant woman: >20 weeks

Compression of
inferior vena cava
15-30 degree lateral tilt:
Cushion under right hip
Reduced cardiac output

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Airway, breathing and circulation

• Done in this order because if the blood is not

oxygenated, there is no point in pumping it
round the body

• Quickly assess airway and breathing, and treat

• Then assess circulation and treat

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 Airway
If Not conscious – Open Jaw thrust
airway

Head tilt and chin lift

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 Breathing and Circulation
• Look for breathing by looking
for movement of the chest

• Listen for breathing or noisy

breathing

• Feel for breathing

• Look for signs of circulation

ie colour etc

• Feel for carotid pulse

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CPR

• If there is no pulse or
other sign of life:

Start chest
compressions

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 Chest compressions
• place heel of first
hand on lower part
of sternum

• place heel of
second hand on
top of first

• interlock fingers

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 Chest compressions
• Keep arms straight
and depress sternum
5-6 cm at a rate of
100-120
compressions per
minute

• Change the person

delivering the
compressions every 2
minutes to avoid
getting tired

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Using resus equipment
• If still not breathing place oropharyngeal
airway Or...

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Using a bag and mask
• Give rescue breaths

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30 compressions: 2 breaths
• Give 2 slow
breaths each
lasting about 1
second

• Watch for chest

rise

• Give oxygen if
available

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Suctioning
• Gentle suction, ONLY if necessary, under direct vision

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Airway and Breathing
If breathing:
• Give oxygen (if available)
• Sit patient up (if alert) or place in recovery position

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Recovery position

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Recovery position

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Recovery position

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Circulation
• Assess
• Colour: Conjunctiva, Capillary refill, Skin
• Skin temperature
• Mental state
• Urine output
• Heart rate
• Blood pressure
• Fetal heart rate

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Circulation

• Colour- pale , greyish

• Skin- cold, hot , sweaty
• Confusion- aggressive , not alert
• Urine output- reduced
• Heart rate- high
• Fetal heart rate- Tachy., Brady., or absent
• Blood pressure- low

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 Circulation

• Place IV lines, take bloods, start IV fluids

• Secondary survey:
• Why is there a circulation problem?
• Stop bleeding
• Treat infection

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 After quick assessment of
AIRWAY and BREATHING

PATIENT NOT BREATHING

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Cardiopulmonary resuscitation

• This is the approach to an apparently

lifeless patient

• Following a rapid assessment of

• Airway and Breathing

• Starting treatment quickly

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RECAP

Unresponsive?

Shout for help!

Primary survey: Assess ABCD and treat :OPEN Airway

Breathing Not breathing

O2+Recovery position CPR 30:2

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Common pitfalls

• Interruptions of chest compression are

common and are associated with reduced
chance of survival

• Chest compressions are often undertaken with

insufficient depth and the wrong rate

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Peri mortem C/S
• Is part of resuscitation

• Performed to try to save the mother

• Improves Circulation because takes weight of

baby away from vena cava

• Prepare for this …

• Carry out if resuscitation has no effect after 5

minutes
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Peri mortem C/S
• Quick! Completed within 5 minutes

• No need to move to operating theatre

• Just need a scalpel – little bleeding

• Any type of skin incision is fine

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References
• BLS resuscitation guidelines, Resuscitation
council United Kingdom:
http://www.resus.org.uk/pages/mediMain.htm

• Life Saving Skills Manual. RCOG press:

http://www.rcog.org.uk/what-we-
do/publishing/books/course-manuals

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