Relief of Aortocaval Compression

UNCONTROLLED WHEN PRINTED

Indications

In the pregnant patient, supine positioning can result in aortocaval compression. The gravid uterus can compress the inferior vena cava and aorta resulting in reduced cardiac output and hypotension.
Manually displace the uterus to the left of pregnant patients in cardiac arrest to relieve aortocaval compression

Contraindications

Patient Factors & Considerations

Do not apply downward pressure as this will increase aortocaval compression.
Evidence supports the use Manual Uterine Displacement over Left Lateral Tilt (LLT) as LLT hinders the ability to perform high-quality chest compressions.

Procedure

Pregnant patient in cardiac arrest should receive high quality CPR with Manual Uterine Displacement (MUD) to relieve aortocaval compression.
Relief of aortocaval compression must be maintained continuously during resuscitative efforts and continued if ROSC is achieved.

Using a two handed technique, cup and lift the uterus leftwards and upwards off the main vessel (Figure B)

Using a 1 handed technique to push the uterus upwards and leftwards off the maternal vessels (Figure A)

Success

Discontinue

Additional Information

References

Images sourced from American Heart Association 2017

Colour assist:

Directorate

Clinical Services

Responsible Manager

Head of Clinical Services

Published Date

Review Date