Obstetric Emergencies

Answer 4 Reposition the Patient.Gravid women develop supine hypotension as the fetus grows. The uterus presses on the great vessels and limits the return of blood to the heart. It is imperative that women late in their second trimester and throughout their third trimester be positioned in such a way that the uterus does not have a detrimental effect on venous return. Placing the woman in the left lateral decubitus position or manually displacing the uterus to the left should be the first step in this patient’s management provided that the airway and breathing are optimized. Elevating the patient’s right hip 10 to 15 cm or manually displacing the uterus relieves aortocaval compression. Intravenous access is important but a central line is not mandatory. This patient will need a pelvic examination at some point but not during the primary examination. Cardiotocographic monitoring is also indicated but does not need to be performed during the initial evaluation.7 REFERENCES 7. Howard BK, Goodson JH, Mengert WF. Supine hypotensive syndrome in late pregnancy. Obstet Gynecol 1953;1:371–7. Click here to return to the questions

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