PROCEDURE
1. Perform hand hygiene and don clean gloves.
2. Place the patient supine on a firm surface and have someone manually displace the uterus to the left or place the patient supine with a wedge under her left hip. (Level VII)
Rationale: The manual uterine displacement method using a one- or two-handed technique while the patient is in a supine position is recommended to optimize the quality of CPR. The left lateral position makes compressions difficult and less effective and is challenging to maintain; with a tilt of greater than 30 degrees, the patient may slip or roll off the supporting surface.3
3. Assess the carotid pulse for no more than 10 seconds. If it is absent, begin chest compressions slightly above the center of the sternum.3 (Level VII)
Rationale: Chest compressions on a pregnant woman are difficult because of flared ribs, the raised diaphragm, obesity, and breast hypertrophy. Because the abdominal contents push the diaphragm upward, the hands should similarly be placed above the center of the sternum for chest compressions.1