Place Pregnant Patients with Right Side Elevated 15 Degrees

Place Pregnant Patients with Right Side Elevated 15 Degrees
Glen Tinkoff MD
A woman in the third trimester of pregnancy is predisposed to hypotension while in the supine or sitting position due to the hemodynamic and anatomic changes of pregnancy. The large uterus of late pregnancy can compress the inferior vena cava (IVC) such that venous return is significantly reduced. This decreased preload can lead to decreased cardiac filling and hence decreased cardiac output and hypotension. This can be especially deleterious in the usual setting of increased cardiac demand in pregnancy.
Of normovolemic pregnant patients, only 8% to 10% display supine hypotension due to adequate physiologic compensation; however, when faced with blood or other fluid losses such as in trauma or critical illness, supine hypotension of late pregnancy is more prevalent. In these instances, simple repositioning can be life saving. Establishing left uterine displacement by elevating the patient's right side greater than 15 degrees allows the uterus to be displaced off the inferior vena cava. After a traumatic injury, before this maneuver is performed assessment of the stability of the patient's spinal cord must be undertaken, and if uncertainly exists, the patient should not be moved without using formal spinal precautions.
Suggested Readings
Kinsella SM, Lohman G. Supine hypotensive syndrome. Obstet Gynecol 1994;83:774.
Ueland K, Metcafe J. Circulatory changes in pregnancy. Clin Obstet Gynecol 1975;18:41.
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