⚡ Maternal Collapse / Cardiac Arrest
IN REVIEWPENDING CLINICAL VERIFICATIONTIME-CRITICAL PROTOCOL
1 RECOGNIZE
- Unresponsive with absent/abnormal breathing: activate the cardiac-arrest response and start CPR; a trained clinician checks pulse without delaying compressions.
- Collapse with a pulse is still an emergency: airway/oxygenation, ECG/BP and urgent cause-directed treatment.
2 CALL FOR HELP
- Call cardiac-arrest team, senior obstetrician, anaesthetist and neonatal team; bring defibrillator and resuscitative-birth equipment immediately.
- Assign a timer/recorder, uterine displacement and early preparation for resuscitative hysterotomy at the arrest location.
3 IMMEDIATE ACTION
- High-quality CPR on a firm surface: 100–120 compressions/min, depth 5–6 cm, full recoil and minimal pauses; 30:2 until an advanced airway. Use usual adult defibrillation energies.
- For a uterus at/above the umbilicus (about ≥20 weeks), maintain MANUAL left uterine displacement during supine CPR. Do not use a tilt that compromises compressions.
- Follow the rhythm-specific adult ALS sequence, including adrenaline IV/IO at the correct time and interval. Obtain IV/IO access and secure oxygenation/ventilation without prolonged compression pauses.
- Prepare resuscitative hysterotomy immediately and perform as soon as possible by the skilled team at the site of arrest. Do not wait for a four-minute alarm or move to theatre before starting preparation.
Drug doses & preparation
Choose the regimen for the stated indication. Alternatives are not instructions to give every medicine. Check prior doses, contraindications, concentration and the response before repeating.
Adrenaline — cardiac arrestResuscitation Council UKchecked
Dose1 mg
RouteIV or IO
FrequencyEvery 3–5 min during CPR; immediately for non-shockable rhythm, after the third shock for shockable rhythm
DurationDuring ongoing resuscitation, until ROSC or team decision
PreparationUse a 1 mg/10 mL (0.1 mg/mL) resuscitation syringe. If using 1 mg/mL stock, 1 mL diluted to FINAL 10 mL gives 0.1 mg/mL; independently check. Flush the IV/IO line and continue compressions
Max dose1 mg each scheduled dose; do not confuse with 0.5 mg IM anaphylaxis treatment
- Indication: Maternal cardiac arrest following the adult ALS algorithm
Monitoring
- Rhythm checks, CPR quality, capnography and reversible causes; use usual defibrillation energy in pregnancy
Contraindications: Do not use an IM anaphylaxis approach to treat cardiac arrest; CPR/defibrillation are not delayed for drugs
4 INVESTIGATIONS (never delaying treatment)
- During resuscitation, glucose, blood gas/electrolytes and focussed ultrasound only when it does not interrupt CPR or treatment.
- Assess standard reversible causes (hypoxia, hypovolaemia, metabolic/electrolyte disturbance, hypothermia, thrombosis, tamponade, tension pneumothorax and toxins) plus obstetric haemorrhage, eclampsia, sepsis and peripartum cardiomyopathy.
5 DEFINITIVE MANAGEMENT
- Treat the cause during CPR: rapid haemorrhage control/blood products, PE reperfusion when indicated, anaphylaxis treatment or correction of electrolyte/drug toxicity as appropriate.
- Resuscitative birth primarily relieves maternal aortocaval compression; neonatal resuscitation is managed by a separate team.
- After ROSC, continue a multidisciplinary post-arrest pathway with oxygenation, ventilation, perfusion, temperature and neurological assessment.
6 ESCALATION
- ICU and cause-specific specialist support after ROSC; consider extracorporeal CPR only within a functioning experienced system.
7 POST-EVENT CARE
- Document the full timeline, rhythms, shocks, drugs, uterine displacement and birth; maternal/neonatal follow-up and family communication.
- Offer team/patient-family debrief and multidisciplinary review.
Admission & discharge after the acute event
Care setting: Emergency admission; critical care and later ward/home transfer are separate steps
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- Admit to the appropriate critical-care setting for respiratory/circulatory/neurological support and definitive investigation/treatment.
When clinic, day care or home care may be suitable
- An unresolved collapse, amniotic-fluid embolism or major organ dysfunction requires hospital care, not direct home discharge.
Before going home
- The cause and ongoing risks have been assessed, acute organ support is no longer required at the proposed destination and the receiving team can provide the agreed care.
- Before home discharge, organ recovery, function, oral treatment/nutrition, mobility and support are adequate, with rehabilitation/specialty follow-up for remaining impairment.
Discharge medicines and treatment changes
- Reconcile all temporary critical-care medicines, continuing prescriptions and indication-specific anticoagulation; document what stopped and why.
Tests, pending results and their reviewer
- Provide a structured critical-care-to-ward handover and assign outstanding diagnostic/organ tests; ward step-down is not itself clearance for home.
Home care and counselling
- Explain the illness/course, likely recovery issues and physical/emotional support; address infant care, bereavement or safeguarding needs when relevant.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
Before each transfer | Name the receiving team, monitoring/rehabilitation plan and urgent escalation triggers. |
At booked post-critical-care/specialty and postnatal reviews | Review organ/function recovery, medicines, mental health and outstanding results. |
Return urgently
- Breathlessness, chest pain, collapse, confusion, seizures, heavy bleeding or recurrent severe illness requires emergency care.
Sources
Resuscitation Council UKcheckedResuscitation Council UKcheckedNICE · CG50, recommendationscheckedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedRCOG · Current public recovery informationchecked