In a pregnant patient with suspected pelvic fracture after a motor vehicle crash, what is the recommended transport position?

• A. Supine with no tilt
• B. Left lateral recumbent
• C. Right lateral recumbent
• D. Prone with a pillow under the abdomen

Answer: (B)

Relieving aortocaval compression is central in transporting a pregnant patient after trauma. When a pregnant uterus sits supine, it can press on the aorta and inferior vena cava, reducing return of blood to the heart and placental perfusion. This can drop maternal blood pressure and compromise fetal oxygen delivery. Shifting to the left side moves the uterus away from those vessels, improving venous return and placental blood flow.

In practice, aim for a left lateral tilt of about 15–30 degrees during transport. If a tilt isn’t easily achieved on a backboard, position the patient on the left side with padding to maintain that tilt as much as possible. While managing a suspected pelvic fracture, continue stabilizing the pelvis and providing airway, breathing, and circulation support, including supplemental oxygen, but prioritize keeping the mother’s perfusion optimized with the left lateral position.

The other postures don’t relieve the compression as effectively and can worsen complications: staying flat with no tilt keeps the vessels compressed; turning to the right doesn’t relieve the aortocaval compression as well; and prone positioning, especially with pelvic injury, is not appropriate and risks further injury and breathing difficulty.

So the best transport position is the left lateral recumbent.