BACKGROUND: Left-lateral tilt position is used to reduce assumed aortocaval compression by the pregnant uterus. METHODS: Magnetic resonance images of 10 singleton parturients at full term and 10 healthy nonpregnant women were obtained for measurement of the abdominal aorta and inferior vena cava volume between the L1-L2 disk and L3-L4 disk levels in both the supine and left-lateral tilt positions (15°, 30°, and 45°) maintained by insertion of a 1.5-m-long polyethylene foam placed under the right side of the parturient's body. RESULTS: Aortic volume did not differ significantly between parturients and nonpregnant women in the supine position (12.7 ± 2.0 vs.12.6 ± 2.1 ml, mean ± SD; mean difference, -0.1; 95% confidence interval [CI], -2.0 to 1.9; P = 0.95). Inferior vena cava volume in the supine position was significantly lower in parturients than in nonpregnant women (3.2 ± 3.4 vs.17.5 ± 7.8 ml; mean difference, 14.3; 95% CI, 8.3-20.2; P < 0.001). Aortic volume in parturients did not differ among left-lateral tilt positions. Inferior vena cava volume in the parturients was not increased at 15° (3.0 ± 2.1 ml; mean difference, -0.2; 95% CI, -1.5 to 1.2; P > 0.99), but was significantly increased at 30° (11.5 ± 8.6 ml; mean difference, 8.3; 95% CI, 2.3-14.2; P = 0.009) and 45° (10.9 ± 6.8 ml; mean difference, 7.7; 95% CI, 2.2-13.1; P = 0.015). CONCLUSIONS: In parturients, the aorta was not compressed, and a 15° left-lateral tilt position did not effectively reduce inferior vena cava compression.
BACKGROUND: Left-lateral tilt position is used to reduce assumed aortocaval compression by the pregnant uterus. METHODS: Magnetic resonance images of 10 singleton parturients at full term and 10 healthy nonpregnant women were obtained for measurement of the abdominal aorta and inferior vena cava volume between the L1-L2 disk and L3-L4 disk levels in both the supine and left-lateral tilt positions (15°, 30°, and 45°) maintained by insertion of a 1.5-m-long polyethylene foam placed under the right side of the parturient's body. RESULTS: Aortic volume did not differ significantly between parturients and nonpregnant women in the supine position (12.7 ± 2.0 vs.12.6 ± 2.1 ml, mean ± SD; mean difference, -0.1; 95% confidence interval [CI], -2.0 to 1.9; P = 0.95). Inferior vena cava volume in the supine position was significantly lower in parturients than in nonpregnant women (3.2 ± 3.4 vs.17.5 ± 7.8 ml; mean difference, 14.3; 95% CI, 8.3-20.2; P < 0.001). Aortic volume in parturients did not differ among left-lateral tilt positions. Inferior vena cava volume in the parturients was not increased at 15° (3.0 ± 2.1 ml; mean difference, -0.2; 95% CI, -1.5 to 1.2; P > 0.99), but was significantly increased at 30° (11.5 ± 8.6 ml; mean difference, 8.3; 95% CI, 2.3-14.2; P = 0.009) and 45° (10.9 ± 6.8 ml; mean difference, 7.7; 95% CI, 2.2-13.1; P = 0.015). CONCLUSIONS: In parturients, the aorta was not compressed, and a 15° left-lateral tilt position did not effectively reduce inferior vena cava compression.
Authors: André Dallmann; Ibrahim Ince; Michaela Meyer; Stefan Willmann; Thomas Eissing; Georg Hempel Journal: Clin Pharmacokinet Date: 2017-11 Impact factor: 6.447
Authors: Peter R Stone; Wendy Burgess; Jordan P R McIntyre; Alistair J Gunn; Christopher A Lear; Laura Bennet; Edwin A Mitchell; John M D Thompson Journal: J Physiol Date: 2016-12-11 Impact factor: 5.182
Authors: Lesley M E McCowan; John M D Thompson; Robin S Cronin; Minglan Li; Tomasina Stacey; Peter R Stone; Beverley A Lawton; Alec J Ekeroma; Edwin A Mitchell Journal: PLoS One Date: 2017-06-13 Impact factor: 3.240