Responding

• An obstetrician and neonatologist should be involved as early as possible (Resuscitation Council UK 2000).

• All principles of basic and advanced life support apply to the pregnant woman.

• Cardiac arrest may be prevented with early intervention. Cardiac output and venous return may be improved by relieving pressure on the inferior vena cava and aorta (AHA & ILCOR 2000). This can be achieved by:

—placing sandbags, pillows or a purpose-made (Cardiff)

wedge under the patient's right buttock and lower back; —placing the patient in the left lateral position; —manually moving the uterus to the left.

• Chest compression is performed in the standard way. The rescuer should be aware that it may be more difficult because of breast hypertrophy and splinting of the diaphragm.

• Arrhythmias should be treated according to standard protocols.

Emergency caesarean section is recommended after five minutes of unsuccessful resuscitation to improve the chances of both fetal and maternal survival (Resuscitation Council UK

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