Der Mythos der 15°-Linksseitenlagerung zur Entlastung der Vena cava inferior

Abstract

Positioning the pregnant patient in her third trimester in a 15° left lateral tilt position with the rationale to reduce inferior vena cava (IVC) compression is a longstanding practice of both obstetric and anesthesia care. Recent data from MRI imaging studies have challenged this traditional dogma, since the IVC was found to remain compressed at a 15° angle, with a tilt of at least 30° necessary to provide a certain relief of the vessel. However, even the 15° tilt is regularly underestimated by visual judgement and improperly executed, but comes with several disadvantages without adding any benefit on fetal outcome. Current evidence supports all efforts to cease the dogma of a 15° left lateral position for its lack of effectiveness and instead put emphasis on proven measures, such as volume coloading and the timely administration of vasopressors.

Das Dogma der 15°-Linksseitenlagerung im geburtshilflichen Setting ist fester Bestandteil geburtshilflicher Praxis und Literatur sowie Teil aktueller Leitlinienempfehlungen – aber ist es auch sinnvoll?

Kernaussagen

• Bei nahezu allen Schwangeren am Termin kommt es in Rückenlage zu einer Kompression der V. cava inferior, aber nicht der Aorta.

• Anders als bei akuten Verschlüssen haben etwa 90% der Schwangeren wirksame Kollateralen über das Azygos-System gebildet, sodass die Kompression der VCI keine relevanten hämodynamischen Einschränkungen zur Folge hat.

• Die traditionelle 15°-Linksseitenlagerung, die noch dazu im klinischen Alltag zur Durchführung der Sectio kaum durchführbar ist, führt nicht zu einer Entlastung der VCI, hierfür wären mindestens 30° notwendig, und es ist zu prüfen, ob eine Links- oder Rechtsseitenlage notwendig ist.

• Seitenlagerungen zur Sectio werden häufig nicht korrekt durchgeführt, haben zahlreiche Nachteile und bringen keinen Vorteil für das fetale Outcome.

• Nach aktueller Datenlage gibt es keinen Grund, an der 15°-Linksseitenlage in der geburtshilflichen Versorgung festzuhalten.

Schlüsselwörter

15°-Linksseitenlagerung - Vena cava inferior - Geburtshilfe - Azygossystem

Keywords

15° left lateral tilt position - inferior vena cava - obstetrics - azygos

Publikationsverlauf

Artikel online veröffentlicht:
29. November 2022

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