Case 15 · Obstetrics
Maternal cardiac arrest
A woman at 34 weeks collapses on the antenatal ward with no pulse. Run CPR that works in late pregnancy with left uterine displacement, follow the non-shockable algorithm, deliver the baby by resuscitative hysterotomy by 5 minutes, and find and treat the cause.
About this case
What you will practise
Learning objectives
- Start high-quality CPR at once and call the maternal arrest team.
- Relieve aortocaval compression with manual left uterine displacement.
- Run the non-shockable (PEA) algorithm: adrenaline, airway, access above the diaphragm.
- Perform resuscitative hysterotomy where she lies, aiming to deliver by 5 minutes.
- Find the cause with the 4 Hs, 4 Ts and obstetric causes, and treat massive PE with thrombolysis.
- Begin post-arrest care.
Key decisions this case tests
- Manual displacement or a wedge tilt?
- Shock or no shock?
- When, and where, do you start the hysterotomy?
- What in the history points to the cause?
- Thrombolysis in pregnancy during an arrest?
Reference basis
- Resuscitation Council UK. Adult advanced life support guidelines (2021).
- European Resuscitation Council Guidelines 2021: cardiac arrest in special circumstances.
- American Heart Association. Cardiac arrest in pregnancy: scientific statement (2015).
- RCOG Green-top Guideline No. 56: Maternal collapse in pregnancy and the puerperium (2019).
Content version 1.0 · November 2026 · clinical review pending. See the Clinical content policy.
Before you start
The physiology is a simplified teaching model: CPR effectiveness, the timing of ROSC after thrombolysis and the baby’s condition are timed for learning, not prediction. Doses follow the cited guidelines but have not yet been signed off by a clinician.
Visle is for education only and is not medical advice. Collapse in pregnancy is an emergency: start CPR and call for help immediately.
Ready for another emergency?
Case 14 puts you in a labour room where the cord has come down below the baby’s head.