A 36 year old female in her third trimester presents with severe abdominal pain and vaginal bleeding. Husband reports a history of drug use and a recent OB assessment showed 4 cm dilation, 30% effacement. Vital signs BP 98/60, P 110, R 20. What should you do?

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Multiple Choice

A 36 year old female in her third trimester presents with severe abdominal pain and vaginal bleeding. Husband reports a history of drug use and a recent OB assessment showed 4 cm dilation, 30% effacement. Vital signs BP 98/60, P 110, R 20. What should you do?

In late pregnancy, the uterus can compress the inferior vena cava and aorta when the mother is lying flat, which worsens blood flow to both mother and baby during hemorrhage. Placing her on the left side (left lateral recumbent) relieves that compression, improves venous return to the heart, stabilizes maternal blood pressure, and enhances fetal oxygen delivery while you arrange urgent obstetric care. This position is preferred over lying flat or with the legs elevated, which can keep the vessel compression and worsen perfusion. Trendelenburg worsens respiratory mechanics and doesn’t reliably improve preload in this scenario, and Sims or other positions don’t address the underlying hemodynamic compromise. So position her on her left side and transport promptly with continued monitoring and supportive care.

In late pregnancy, the uterus can compress the inferior vena cava and aorta when the mother is lying flat, which worsens blood flow to both mother and baby during hemorrhage. Placing her on the left side (left lateral recumbent) relieves that compression, improves venous return to the heart, stabilizes maternal blood pressure, and enhances fetal oxygen delivery while you arrange urgent obstetric care. This position is preferred over lying flat or with the legs elevated, which can keep the vessel compression and worsen perfusion. Trendelenburg worsens respiratory mechanics and doesn’t reliably improve preload in this scenario, and Sims or other positions don’t address the underlying hemodynamic compromise. So position her on her left side and transport promptly with continued monitoring and supportive care.

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