Pregnant patients who experience cardiac arrest should be treated using current ACLS guidelines. Defibrillation has never been found to have adverse effects on the fetus and thus is not contraindicated. The patient should be placed in the left lateral tilt position if possible prior to defibrillation or cardioversion. Large-bore intravenous lines should be placed, preferably above the diaphragm, and lactated Ringer's or normal saline solution infused. Supplemental oxygen should be given. APGAR scores and fetal outcome are positively affected by greater fetal oxygen reserves.14 In limited published reports, the standard medications used in ACLS have not been demonstrated to have adverse effects on the fetus and thus are recommended in the setting of cardiac arrest.15 See Table 12-3 for details regarding ACLS
medications. Vasopressors, such as epinephrine and dopamine, may be detrimental in the setting of maternal hypotension, since they cause uteroplacental vasoconstriction, but should be used as needed during cardiac arrest. In the setting of hypotension alone without cardiac arrest, ephedrine, in standard doses, is the preferred pressor when fluids fail to restore adequate blood pressure. (The dose is 5 mg Iv q 5 min until a response is seen.) The use of sodium bicarbonate is not well studied. Sodium bicarbonate crosses the placenta slowly and can potentially be problematic for the fetus for the following reason. Rapid correction of maternal metabolic acidosis will decrease maternal respiratory compensation and lead to a rise in or normalization of maternal P co2. As maternal Pco2 increases, the concomitant rise in fetal Pco2 occurs at a faster rate than does the rise in HCO3-, causing the fetus to become more acidotic.
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