In which position is a pregnant lady to be placed on the delivery room table for a caesarean section?

DSSSB -28 August 2019 (Shift-2)

Obstetrics & Gynaecology

Medium

Appeared in: DSSSB -28 August 2019 (Shift-2)

Explanation

Placing a wedge under the right hip tilts the patient's body to the left.
This maneuver, known as left uterine displacement (LUD), shifts the heavy, gravid uterus off the inferior vena cava and aorta.
It prevents aortocaval compression, also called supine hypotensive syndrome, which can cause a sudden drop in maternal blood pressure.
Maintaining stable maternal blood pressure is crucial for ensuring adequate uteroplacental blood flow and oxygen supply to the fetus.

Option B: This position places direct pressure on the gravid uterus, compromising fetal blood supply and maternal respiration. It is completely contraindicated and physically impossible for a patient at term.
Option C: This position increases pressure on the diaphragm from the abdominal organs and the gravid uterus, which can impair breathing. It does not effectively relieve aortocaval compression.
Option D: While comfortable, this position does not provide sufficient lateral tilt to displace the uterus off the major blood vessels. It is inadequate for preventing supine hypotension during a surgical procedure.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Patient positioning for caesarean section and prevention of aortocaval compression as background academic context rather than a clinical decision trigger.
Proper positioning is a critical nursing and anesthesia responsibility to prevent maternal hypotension and ensure fetal well-being during a C-section.
Nurses must monitor blood pressure frequently (e.g., every 1-2 minutes initially) after the patient is positioned and regional anesthesia (like a spinal or epidural) is administered.
What if? - If a wedge is unavailable in an emergency, a nurse can perform manual left uterine displacement (LUD) by using their hands to physically push and hold the uterus to the patient's left side.

How to Approach the Question

First, identify the core of the question: finding the correct and safe position for a C-section.
Recall the major physiological change in late pregnancy when a patient is supine: the gravid uterus can compress major blood vessels (the aorta and inferior vena cava).
Consider the primary goal of positioning: to prevent this compression, which causes a condition called supine hypotensive syndrome.
Evaluate each option based on this goal. Ask yourself, 'Does this position move the uterus off the vena cava and aorta?'
The supine position with a wedge under the right hip is the only option that achieves the necessary left lateral tilt to displace the uterus.
Eliminate the other options based on safety and physiology: Prone is impossible and dangerous, Trendelenburg worsens respiratory issues, and Semi-Fowler's is insufficient to prevent compression.

Concept Tested & Keywords

Concept Tested: Patient positioning for caesarean section and prevention of aortocaval compression.
Stem keywords: pregnant lady, delivery room table, caesarean section, position
Lead-in keywords: In which position
Clinical cues: caesarean section (indicates late-stage pregnancy and surgical need)
Negative lead-in flag: false

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 pp. 106-108, 92-94

E6 Nursing Fundamentals Taylor p. 208-210