• K Saravanakumar, M Hendrie, F Smith, and P Danielian.
• Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK. Electronic address: saravanakumark@abdn.ac.uk.
• Int J Obstet Anesth. 2016 May 1; 26: 15-8.

IntroductionObese pregnant women are at risk of aortocaval compression and associated hypotension with neuraxial anaesthesia. We hypothesised that addition of reverse Trendelenburg tilt to the standard practice of pelvic tilt may attenuate aortocaval compression.MethodsAfter ethical approval and consent, six women with a singleton pregnancy and booking body mass index of 30-35kg/m(2) underwent magnetic resonance imaging scanning in six different positions: right lateral decubitus; left lateral decubitus; supine with pelvic tilt; and reverse Trendelenburg positions of 5°, 10° and 15°. Dimensions of the inferior vena cava and abdominal aorta at the L2-3 intervertebral disc level were obtained from axial images using medical imaging software OsiriX™.ResultsInferior vena cava dimensions were higher in left lateral decubitus position compared to supine with pelvic tilt (P=0.002). Inferior vena cava compression was noted in all participants (59±33%, 95% CI 32 to 86). Addition of 15° reverse Trendelenburg tilt to standard pelvic tilt produced a non-statistically significant increase in inferior vena cava area (10.54±9.91cm(2), 95% CI 2.61 to 18.47, P=0.06).ConclusionA non-statistically significant improvement of aortocaval compression was noted with the addition of 15° reverse Trendelenburg tilt to the supine with pelvic tilt position in obese pregnant women.Copyright © 2015 Elsevier Ltd. All rights reserved.

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