In a third-trimester pregnant patient with suspected supine hypotension, what is the ideal position?

• A. Left lateral decubitus position to relieve aortocaval compression.
• B. Supine with legs elevated.
• C. Right lateral decubitus.
• D. Trendelenburg.

Answer: (A)

In late pregnancy, the enlarged uterus can press on the inferior vena cava when a patient lies on her back, reducing venous return and causing maternal hypotension and decreased placental perfusion. The ideal position to relieve this compression is the left lateral decubitus position. Lying on the left side shifts the uterus off the great vessels, restores venous return, increases maternal cardiac output, and improves uteroplacental blood flow. Other positions fail to relieve the compression as effectively: staying supine keeps the vessels compressed; leg elevation while supine doesn’t move the uterus off the vessels; right lateral decubitus is less effective than left; Trendelenburg worsens breathing and doesn’t specifically address the aortocaval compression.