Do we need to deal with the hypotension caused by lateral position?

[Jiayou]

Hello,

I am not sure if any of you encountered such a problem, but I was bothered by this question for a while. When I turn my patients to lateral position, most of them will develop hypotension. I am wondering if we need to do some intervention for that or just leave it alone.

For example, my patient last night had BP 121/69. When the tracing showed that she had two variable decelerations, I turned her to left lateral position right away. A few minutes later, her BP dropped to 92/45. I was really confused what I supposed to do. One of my experienced coworkers had told me that because the hypotension was caused by the lateral position, we don't need to do anything. However, hypotension will also cause uteroplacenta insufficiency, right? Do I need to turn patient back to normal semi-Fowler's position in order to get BP back to normal or just leave it alone? Any idea will be appreciated.

[SmilingBluEyes]

I would simply put the patient in whatever position is optimal for best placental perfusion and leave it at that. For some babies, that is left, for others,that is right. You can't treat everyone the same. You learn that as you go along. And you treat each person individually as the situation demands.

[Jiayou]

Thank you SmilingBluEyes for your response. I appreciate that.

Do you mean we still need to pay attention to hypotension caused by lateral position? If patient has low BP in one side, we need to turn to other side to get optimal placenta perfusion? Will the BP be different when putting pt in different sides? I though they are the same. Maybe next time I will put patients in different sides to check if there are any differences.

[feisty]

We were taught to monitor mean arterial pressure with the change. This may be something you would want to consider when evaluating need for intervention. FHR response to all the interventions is key though.

[feisty]

If you put the patient on different sides and keep the blood pressure cuff on one arm you will get different readings. The left lateral position with the cuff on the right arm will give you a lower reading than you would get if your patient were in the same position with the cuff on the left arm.

[CMCRN]

feisty is exactly right

[Jiayou]

We were taught to monitor mean arterial pressure with the change. This may be something you would want to consider when evaluating need for intervention. FHR response to all the interventions is key though.

Thank you Feisty for your response. I appreciate that. It is very interesting to hear that making judgment based on mean arterial pressure. Do you have any evidence based research? Because it is my first time hearing that, I am eager to learning more... Thanks.

[RNLaborNurse4U]

Pregnant women can have some wicked low BP readings, especially post epidural placement. The most important things to consider: how does the baby look on EFM? How is mom feeling? What is the entire clinical picture?

If baby's tracing is good, I would not necessarily worry about some transient hypotension. Yes, BP will be lower on either lateral side - you have optimal uteroplacental perfusion on either lateral side.

Now, if mom's BP tanks, and she looks bad/feels bad (n/v, pale/gray color, generally feels like crap), then give her an IV fluid bolus and/or reposition her.

If she's freshly post epidural and her BP tanks, and she's symptomatic, or the baby tanks on EFM, then you MUST intervene. IV bolus first. Reposition to other lateral side. Possible need to give ephedrine IV push (you should have standing orders for this from anesthesia for post epidural hypotension below 90 systolic).

[Jiayou]

thank you so much rnlabornurse4u for your explanations. they really make sense to me. i appreciate that.

[RNLaborNurse4U]

Not a problem! We're all hear to help each other out

[SmilingBluEyes]

I agree with not only worrying about numbers, but symptoms. Pay attention to how the mom feels and fetal response.

[NurseNora, BSN, RN]

I'm betting your patient isn't really hypotensive. If the arm is above the heart (the top arm) the BP will be spuriously low. That's why ideally the BP should be taken in the same arm with the patient in the same position each time.

Try this on one of your coworkers some "quiet" shift. Take the BP in a sitting or Semi Fowlers position, then on each side with the BP cuff on the same arm. Pregnant women can show even greater change than non pregnant people.

If you're taking a BP in the top arm of a patient on her side, have her lean forward a little and drop that arm in front of her so the cuff is at about the same level as her heart, it will be more accurate.