Cardiopulmonary Resuscitation in Pregnancy Complete Steps

The following is a complete step by step how to Cardiopulmonary Resuscitation in Pregnancy. We know and are aware that pregnancy has a myriad of risks, including heart and lung failure.
 
For this reason, health workers who are directly related to pregnancy need to be equipped with complete skills on the procedures for Cardiopulmonary Resuscitation.
 

Complete Step by step how to do Cardiopulmonary Resuscitation in Pregnancy.

 
Here are the steps for cardiopulmonary resuscitation in accordance with the correct rules.
  • Check the mother's consciousness by calling or shaking the mother's body. If the mother is not aware, take the next steps.
  • Call for help from other health workers and work as a team.
  • Especially for mothers with gestational age >20 weeks (uterus above the umbilicus), tilt the mother in a lying position to the left side at an angle of 15-30° or if this is not possible, push the uterus to the left side (see the following picture).
left side at an angle of 15-30° 
Push the uterus to the left
Push the uterus to the left
 
  • Clear the airway. Tilt the mother's head back (head tilt) and lift the chin (chin lift). Clear foreign bodies in the airway.
  • Cardiopulmonary Resuscitation in Pregnancy
    chest thrust
  • If there is a solid blockage in the airway, sweep it out with your fingers or apply a chest thrust to the center of the sternum (chest thrust). Avoid pressing the xiphoid process!
  • While keeping the airway open, "see - hear - feel" the mother's breath (do it fast, less than 10 seconds) by bringing the rescuer's head closer to the mother's face. See chest movement, hear breath sounds, and feel the air flow from the mother's nose/mouth.
 assessment of breathing
  • If the mother is breathing normally, maintain the position, give oxygen as a supportive measure. Continue monitoring to ensure the mother is breathing normally.
  • If the mother is not breathing or breathing abnormally, check the carotid artery pulse rapidly (no more than 10 seconds).
    check carotid pulse
    check carotid pulse
  • If the pulse is palpable but the mother is not breathing or gasping for air (gasping), give rescue breaths (ventilation) using a mask or mouth to mouth using a pad (such as cloth, gauze) once every 5-6 seconds. Ensure that the volume of the rescue breath is sufficient so that chest expansion is visible. Check the carotid artery pulse every 2 minutes.
  • If the pulse is not palpable, immediately perform cardiopulmonary resuscitation.
 
    mouth to mouth breath
    mouth to mouth breath
  1. Cardiopulmonary resuscitation in women with gestational age > 20 weeks is performed in the mother's position tilted to the left by 15-300.
  2. Chest compressions are made in the middle of the sternum. Compressions are performed quickly and steadily, pressing the sternum to a depth of 5 cm at a rate of 100-120x/min.
  3. After 30 compressions, reopen the airway and give 2 ventilation using a mask-balloon or mouth-to-mouth with a pad. Each ventilation is given within 1 second. Provide adequate ventilation so that chest expansion is visible.
  4. breathing assistance with balloons and masks
    breathing assistance with balloons and masks
  5. Then continue chest compressions and ventilation in a ratio of 30:2 
  6. chest compression
    chest compression
  7. Insert an intravenous cannula (2 lines if possible) using a large needle (no. 16 or 18 or largest size available) and administer fluids according to the mother's condition.
  • Cardiopulmonary resuscitation measures are continued until:
  1. A better trained team to treat respiratory and cardiac arrest have arrived and taken action, OR
  2. No response after 30 minutes, OR
  3. Fatigue helper, OR
  • Mother shows signs of regaining consciousness, eg coughing, opening eyes, talking or moving consciously AND begins to breathe normally. In this case, continue the treatment with:
    • Give oxygen
    • Insert an intravenous cannula (if previously unsuccessful) and give fluids according to the mother's condition
    • Continue monitoring to ensure that the mother is breathing normally.
  • Once the airway, breathing, and circulation problems are resolved, think about and evaluate possible causes of the mother's loss of consciousness, including:
  1. heavy bleeding (most often)
  2. thromboembolic disease
  3. heart disease
  4. sepsis
  5. drug poisoning (eg magnesium sulfate, local anesthetics)
  6. eclampsia
  7. intracranial haemorrhage
  8. anaphylaxis
  9. metabolic/electrolyte disturbances (eg, hypoglycemia)
  10. hypoxia due to airway compromise and/or lung disease
  • Perform follow-up examinations, such as abdominal ultrasound to look for hidden intra-abdominal bleeding.
  • Address the cause of loss of consciousness or refer if facilities are not possible.
That's the complete skill step by step Cardiopulmonary Resuscitation in Pregnancy. Hopefully with this skill, many pregnant women's lives will be saved.

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