A woman in active labor has a nonreactive cardiotocograph and is being prepared for emergency cesarean section. Which position should the nurse use to reduce aortocaval compression?

1. A

   Supine with a wedge under the right hip

2. B

   Supine with a wedge under the left hip

3. C

   Trendelenburg position

4. D

   Lithotomy position

Appeared in: NORCET-11 Mains

Explanation

• Aortocaval compression, or supine hypotensive syndrome, occurs when the gravid uterus compresses the inferior vena cava and aorta against the spine in the supine position.
• This compression reduces venous return to the heart, leading to maternal hypotension and decreased blood flow to the placenta, which can cause or worsen fetal distress.
• The inferior vena cava is located to the right of the vertebral column.
• Placing a wedge under the right hip effectively displaces the uterus to the left, relieving pressure on these major blood vessels.
• This simple maneuver improves maternal cardiac output and enhances uteroplacental perfusion, a critical intervention for a nonreactive fetal heart tracing.

Why Other Options Were Wrong

• Close distractor alert - Option B: Placing a wedge under the left hip would tilt the uterus to the right, which could increase pressure on the inferior vena cava, as it is situated on the right side of the spine.
• Option C: The Trendelenburg position is not the primary intervention for aortocaval compression and can impair respiratory function in a pregnant patient due to the upward pressure of the abdominal contents on the diaphragm.
• Option D: The lithotomy position is designed for vaginal delivery and gynecological procedures, not for relieving aortocaval compression during preparation for a cesarean section.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Maternal positioning to prevent aortocaval compression (supine hypotensive syndrome) in acute care settings.
• Left uterine displacement is a critical and immediate nursing action to prevent or correct supine hypotension and subsequent fetal distress.
• This intervention is essential during any procedure requiring a pregnant woman to be supine, including epidural placement, spinal anesthesia, and cesarean section.
• Failure to alleviate aortocaval compression can lead to severe maternal hypotension and profound fetal bradycardia or acidosis.

How to Approach the Question

• First, identify the core clinical problem: a nonreactive cardiotocograph suggests fetal distress, and the question asks how to correct a potential cause, aortocaval compression.
• Recall the relevant anatomy and physiology: The large, pregnant uterus can compress the inferior vena cava and aorta when the mother is supine. The inferior vena cava is on the right side of the body.
• Determine the therapeutic goal: To relieve the compression, the uterus must be shifted off these vessels, specifically to the left.
• Analyze the options to determine which action achieves this goal. A wedge under the right hip will tilt the uterus to the left.
• Eliminate the other options. A wedge under the left hip would worsen the problem. Trendelenburg and lithotomy positions are used for different clinical purposes and do not specifically address aortocaval compression.

Concept Tested & Keywords

• Concept Tested: Maternal positioning to prevent aortocaval compression (supine hypotensive syndrome).
• Stem keywords: active labor, nonreactive cardiotocograph, emergency cesarean section, aortocaval compression
• Lead-in keywords: Which position
• Clinical cues: A nonreactive cardiotocograph is a sign of potential fetal distress, making interventions to improve placental perfusion urgent.

Question ID

QVJ__Bz5hhnObuFkMIN0do

Copy ID

Reference Book

E6 Obstetrics Williams p. 39-57

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 92-94