Maternal collapse and resuscitation in pregnancy

The emergency buzzer goes at 21:40 and you arrive to a 33-year-old two hours after a caesarean, grey, unresponsive, with a midwife shaking her shoulder. Nobody is compressing. Nobody has said the word "arrest". Everything that happens in the next sixty seconds is decided by whether you take the room — and by whether you know the four things that are different about resuscitating a pregnant woman.^[1][4]

Overview and definition

RCOG Green-top Guideline 56 gives the definition worth quoting verbatim: an acute event involving the cardiorespiratory systems and/or brain, resulting in a reduced or absent conscious level (and potentially death), at any stage in pregnancy and up to six weeks after birth.^[1]

Two words in that definition do the work. "Potentially" — collapse is not synonymous with arrest, and most collapsed women still have a pulse. "Six weeks" — the postnatal woman at home is still an obstetric patient, and the causes shift as the weeks pass.^[1][4]

References20ShowHide

1. [1]Chu J, Johnston TA, Geoghegan J Maternal Collapse in Pregnancy and the Puerperium: Green-top Guideline No. 56 BJOG, 2020.PMID 31845507
2. [2]Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association Circulation, 2015.PMID 26443610
3. [3]Lipman S, Cohen S, Einav S, et al. The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy Anesth Analg, 2014.PMID 24781570
4. [4]Beckett VA, Knight M, Sharpe P The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study BJOG, 2017.PMID 28233414
5. [5]Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances Resuscitation, 2021.PMID 33773826
6. [6]Mhyre JM, Tsen LC, Einav S, Kuklina EV, Leffert LR, Bateman BT Cardiac arrest during hospitalization for delivery in the United States, 1998-2011 Anesthesiology, 2014.PMID 24694844
7. [7]Zelop CM, Einav S, Mhyre JM, Martin S Cardiac arrest during pregnancy: ongoing clinical conundrum Am J Obstet Gynecol, 2018.PMID 29305251
8. [8]Holmes S, Kirkpatrick ID, Zelop CM, Jassal DS MRI evaluation of maternal cardiac displacement in pregnancy: implications for cardiopulmonary resuscitation Am J Obstet Gynecol, 2015.PMID 25981849
9. [9]Delgado C, Dawson K, Schwaegler B, Zachariah R, Einav S, Bollag L Hand placement during chest compressions in parturients: a pilot study to identify the location of the left ventricle using transthoracic echocardiography Int J Obstet Anesth, 2020.PMID 32574884
10. [10]Enomoto N, Yamashita T, Furuta M, Tanaka H, Ng ESW, Matsunaga S, Sakurai A Effect of maternal positioning during cardiopulmonary resuscitation: a systematic review and meta-analyses BMC Pregnancy Childbirth, 2022.PMID 35216559
11. [11]Ip JK, Campbell JP, Bushby D, Yentis SM Cardiopulmonary resuscitation in the pregnant patient: a manikin-based evaluation of methods for producing lateral tilt Anaesthesia, 2013.PMID 23710619
12. [12]Kikuchi J, Deering S Cardiac arrest in pregnancy Semin Perinatol, 2018.PMID 29246735
13. [13]Katz VL, Dotters DJ, Droegemueller W Perimortem cesarean delivery Obstet Gynecol, 1986.PMID 3528956
14. [14]Katz V, Balderston K, DeFreest M Perimortem cesarean delivery: were our assumptions correct? Am J Obstet Gynecol, 2005.PMID 15970850
15. [15]Einav S, Kaufman N, Sela HY Maternal cardiac arrest and perimortem caesarean delivery: evidence or expert-based? Resuscitation, 2012.PMID 22613275
16. [16]Rose CH, Faksh A, Traynor KD, Cabrera D, Arendt KW, Brost BC Challenging the 4- to 5-minute rule: from perimortem cesarean to resuscitative hysterotomy Am J Obstet Gynecol, 2015.PMID 26212180
17. [17]Pacheco LD, Saade G, Hankins GD, Clark SL Amniotic fluid embolism: diagnosis and management Am J Obstet Gynecol, 2016.PMID 26987420
18. [18]Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial Lancet, 2002.PMID 12057549
19. [19]Neal JM, Neal EJ, Weinberg GL American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version Reg Anesth Pain Med, 2021.PMID 33148630
20. [20]Cao D, Arens AM, Chow SL, et al. Part 10: Adult and Pediatric Special Circumstances of Resuscitation: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation, 2025.PMID 41122889