A 28-year-old woman at 32 weeks of gestation collapses in the labour ward and is found pulseless. CPR is started immediately by the team. The MOST appropriate next modification to standard resuscitation is:
- A Place her in the left lateral decubitus position throughout the arrest
- B Perform continuous manual left uterine displacement while chest compressions continue ✓
- C Elevate the right side using a wedge and pause compressions during each relief of aortocaval compression
- D Perform immediate perimortem caesarean delivery before any further compressions
Correct answer: B. Perform continuous manual left uterine displacement while chest compressions continue
Explanation
Beyond about 20 weeks, the gravid uterus causes aortocaval compression and reduces venous return, so manual left uterine displacement is performed continuously while high-quality supine compressions continue. Lateral positioning compromises compression quality and is not recommended. Resuscitative hysterotomy is considered if there is no ROSC within about 4 to 5 minutes, not before CPR. Wedge tilting alone displaces the torso and degrades compressions.
Reference: AHA ACLS Provider Manual, 2020 guidelines ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.