Delivery of the fetus is ultimately the only way to eliminate ACC as a component of haemodynamic instability. Late term pregnancy is associated with a propensity for arterial hypoxaemia, airway management difficulty and pulmonary aspiration. In true CPA during pregnancy, the usual resuscitation drugs are indicated. Pregnancy is associated with blunted responsiveness to beta-agonists. Adrenaline will reduce uteroplacental blood flow, but this must be weighed against the systemic effect of supporting cardiac perfusion and output.
Drugs can have unexpected effects, eg.
Bretylium may be the anti-arrhythmic of choice in LA toxicity with refractory ventricular tachyarrhythmia. Lateral patient positioning simplifies electrical cardioversion with anterior-posterior paddle placement.