Although a rare event, every emergency clinician should be prepared to resuscitate the pregnant patient in cardiac arrest. The most common causes of cardiac arrest during pregnancy include pulmonary embolism, cardiomyopathy, hypertensive disorders in pregnancy (such as eclampsia), and hemorrhage. Identifying the etiology may help guide the use of additional therapies beyond advanced cardiac life support (ACLS). In general, the management of pregnant patients in cardiac arrest is like nonpregnant patients, but there are several key differences including patient positioning, airway management, and early consideration of resuscitative hysterotomy. Patients who suffer cardiac arrest and are greater than 20 weeks gestation benefit from resuscitative hysterotomy to relieve aortocaval compression and increase venous return. If return of spontaneous circulation is achieved, patients should be managed in an intensive care unit that can provide adequate postpartum care and targeted temperature management.