It’s classic teaching that in supine patients who are pregnant, the weight of the gravid uterus will compress the descending aorta and inferior vena cava. Respectively, this will increase afterload and decrease preload, with the end result being a reduction in cardiac output and blood pressure. On an average day in a pregnant woman’s life this doesn’t result in too much distress, but, since most of our sickest patients end up supine while we are treating them, it becomes a bigger issue should a gravid patient require resuscitation.
As we’ve all been trained, the answer to this problem is simple, of course – tilt the patient on her side and boom, she’s better. However, like most of what we are taught in the classroom, there’s a lot more nuance to how we should handle these patients in actual practice, so lets review some finer points..