Management of Hypotension in Pregnant Women

Causes and Assessment

Physiologic changes of pregnancy, such as vasodilation due to hormonal changes, can lead to hypotension in pregnant women, according to the European Society of Cardiology 1
Position-related hypotension, including supine hypotensive syndrome from compression of the inferior vena cava, can occur in pregnant women, as noted by the European Society of Cardiology 2
Orthostatic hypotension is more common in pregnancy due to increased blood volume, as reported by the European Society of Cardiology 3
Iatrogenic causes, such as excessive antihypertensive therapy in women with hypertensive disorders, can lead to hypotension in pregnant women, according to the American Heart Association 4
Blood pressure should be measured after the patient sits or lies for 5 minutes, then again at 1 and/or 3 minutes after standing to test for orthostatic hypotension, as recommended by the European Society of Cardiology 3

Left lateral decubitus positioning can relieve inferior vena cava compression and improve venous return, as suggested by the European Society of Cardiology 2
Adequate oral hydration is essential to maintain intravascular volume and prevent hypotension in pregnant women, according to the European Society of Cardiology 5
Compression stockings can improve venous return and reduce the risk of hypotension in pregnant women, as reported by the European Society of Cardiology 3
Intravenous fluid boluses can be used to treat acute symptomatic hypotension in pregnant women, as recommended by the European Society of Cardiology 5
Vasopressors may be considered in severe cases of hypotension, but should be used with caution, as noted by the European Society of Cardiology 6

Pre-hydration with intravenous fluids before regional anesthesia can help prevent hypotension in pregnant women, according to the European Society of Cardiology 1
Left lateral tilt positioning during cesarean section can help prevent hypotension in pregnant women, as recommended by the European Society of Cardiology 5
Antihypertensive drugs should be reduced or ceased if diastolic blood pressure falls below 80 mmHg in pregnant women, as suggested by the American Heart Association 4
Target diastolic blood pressure should be 85 mmHg in office settings, and systolic blood pressure should be 110-140 mmHg, according to the American Heart Association 4

Regular blood pressure monitoring throughout pregnancy is essential to detect and manage hypotension, as recommended by the European Society of Cardiology 5
Assessment of fetal growth and well-being with ultrasound is necessary if persistent hypotension is present, according to the American Heart Association 4

Maintaining adequate hydration throughout pregnancy can help prevent hypotension and improve fetal outcomes, as suggested by the European Society of Cardiology 5
Avoiding prolonged standing or lying in supine position can help prevent hypotension in pregnant women, according to the European Society of Cardiology 2
Regular prenatal care is essential to monitor maternal and fetal well-being and prevent adverse outcomes, as recommended by the American Heart Association 4

Left lateral decubitus positioning is critical to relieve inferior vena cava compression and improve venous return, particularly after 20 weeks gestation when the gravid uterus can compress the inferior vena cava and impede venous return, as recommended by the American Heart Association 7, 8
Manual left lateral uterine displacement effectively relieves aortocaval pressure in patients with hypotension, according to the American College of Cardiology 7, 8

Do not delay positional interventions, such as left lateral positioning, while pursuing other treatments, as advised by the American Heart Association 7, 8

During labor and delivery in women with hypertensive disorders, antihypertensive treatment should be continued to keep SBP <160 mmHg and DBP <110 mmHg, as recommended by the European Society of Cardiology 9