Maternal and fetal effects of the supine and pelvic tilt positions in late pregnancy

Abstract

Material and fetal cardiovascular effects of position change were assessed in 20 women in late pregnancy. On changing from the left lateral to the supine position, there was a 45% reduction in leg blood flow, measured by strain gauge plethysmography. Arterial resistance, measured with Doppler ultrasound in the femoral, brachial and uterine arteries, remained unchanged, confirming the absence of compensatory vasoconstriction. There was no change in blood pressure (BP) in the leg, indicating no significant aortic compression, but a rise in maternal heart rate in the supine position suggested the presence of inferior vena cava (IVC) compression. Neither the left or the right pelvic-tilt position was associated with a significant change in leg blood flow or maternal heart rate compared to the supine position. A possible ‘sluice’ effect in the placental circulation was not confirmed, as fetal heart rate and umbilical Doppler resistance did not change in any position. In the absence of active vasoconstriction and significant aortic compression, IVC compression is the likely cause of the decrease in leg blood flow, and also of the previously demonstrated decrease in uterine blood flow. Leg BP and Doppler ultrasound measurements of uterine artery resistance may not be adequate measures of the effect of posture on uteroplacental perfusion.