Final answer:
In a pregnant patient experiencing cardiac arrest, high-quality CPR with left uterine displacement and activation of specialized resuscitation teams are crucial. The placement of AED pads away from breast tissue and consideration of resuscitative cesarean delivery may be necessary, while fetal monitoring is not an immediate priority.
Step-by-step explanation:
When caring for a pregnant patient in cardiac arrest, especially one who is 30 weeks gestation with the fundus above the umbilicus, specific steps must be taken to optimize outcomes for both the mother and the fetus. These steps include:
- Activating maternal and neonatal resuscitation teams to ensure that specialized care is available for both the mother and the newborn.
- Providing continuous high-quality CPR and performing left uterine displacement to relieve pressure from the aorta and inferior vena cava, which can improve maternal hemodynamics.
- Ensuring that the AED pads are placed correctly and do not incorporate any breast tissue, which could interfere with the delivery of shocks.
- Applying fetal monitors is not a priority during active maternal cardiac arrest, as immediate maternal resuscitation takes precedence.
- While it has been previously suggested to place the patient in the left lateral decubitus position during CPR, the current focus is on uninterrupted high-quality chest compressions, with left lateral tilt or manual uterine displacement as an adjunct.
- Resuscitative cesarean delivery (RCD) might be considered if the gestational age is above 20 weeks and if the provider is trained, ideally within 5 minutes of arrest to improve survival chances for both the mother and the fetus.
In summary, the priority is on high-quality CPR and adaptations to support the unique physiological changes during pregnancy, which may include performing an RCD if conditions permit.