When implementing mCPR in a pregnancy over 20 weeks, what should be done with the uterus?

When implementing manual cardiopulmonary resuscitation (mCPR) in a pregnant patient over 20 weeks gestation, it is essential to manage the uterus to optimize blood flow and reduce pressure on major blood vessels. Pushing the uterus to the left side is the correct approach, as this position helps alleviate pressure from the inferior vena cava, which can be compressed by the enlarged uterus when a patient is in a supine position.

In the later stages of pregnancy, particularly after 20 weeks, the bulk of the uterus can interfere with venous return to the heart and can result in decreased cardiac output and potentially lead to supine hypotensive syndrome. By displacing the uterus to the left, there is an improvement in venous return and circulation, which is critical for effective CPR.

While other positions like leaving the uterus neutral or pushing it to the right might not optimally relieve pressure on the vena cava, elevating the uterus above the chest is not practically achievable during resuscitation efforts. Therefore, maneuvering the uterus to the left side is a standard practice that helps maintain effective perfusion during resuscitation in pregnant patients.