A 24-year-old primigravid woman at 36 weeks gestation comes to the physician complaining of lightheadedness and nausea at bedtime. Her pregnancy has been uncomplicated and her past medical history is unremarkable. She takes one multivitamin and one iron tablet daily. Her blood pressure is 115/75 mm Hg when sitting, 110/70 mm Hg when standing, and 80/60 mm Hg when supine. Physical examination shows a uterus consistent in size with 36 weeks gestation. Which of the following is the most likely explanation for this patient's hypotension while supine?

Question

A 24-year-old primigravid woman at 36 weeks gestation comes to the physician complaining of lightheadedness and nausea at bedtime.  Her pregnancy has been uncomplicated and her past medical history is unremarkable.  She takes one multivitamin and one iron tablet daily.  Her blood pressure is 115/75 mm Hg when sitting, 110/70 mm Hg when standing, and 80/60 mm Hg when supine.  Physical examination shows a uterus consistent in size with 36 weeks gestation.  Which of the following is the most likely explanation for this patient's hypotension while supine?

Quizplus · Accepted Answer

Eductional Objective: Pregnant women > 20 weeks gestation can experience compression of the inferior cava by the gravid uterus while in the supine position.  This reduces venous return and cardiac output, which can result in hypotension and syncope.

A 24-Year-Old Primigravid Woman at 36 Weeks Gestation Comes to the Physician