Make the following minor adjustments to ACLS in the pregnant patient:

• Assign one team member to grab the uterus and manually displace it to the left
• Chest compressions should be done slightly higher on the sternum
• Aim for IV access above the diaphragm
• Amiodarone is pregnancy class D – but I don’t think you should be using that anyway
• Be prepared for a difficult airway. Airway edema may necessitate use of a smaller ETT. Regurgitation is more common. Desaturation will occur more quickly because of decreased FRC and increased oxygen demands

Estimate gestational age by palpating the uterus. If the fundus is above the umbilicus, assume 24 weeks gestation, and therefore viability. At the same time, prep the abdomen with chlorhexidine.

If fundus above the umbilicus and more than 4 minutes have passed, proceed to The peri-mortern c-section