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Supine Hypotensive Syndrome: gravid uterus can significantly impact maternal hemodynamics through mechanical compression of major vessels, with potential effects on both maternal and fetal wellbeing. Inferior Vena Cava (IVC) Effects Occlusion of IVC by gravid uterus Decreased venous return to right ventricle Can occur as early as 20 weeks gestation → decreased cardiac output and organ perfusion Aortic Effects Partial compression of aorta occurs Creates differential blood pressure pattern: Increased BP in upper extremities Decreased BP in lower extremities Reduced blood flow to uterine arteries Uterine Blood Flow Changes Decreased uterine blood flow overall Uterine blood flow = uterine artery pressure - venous pressure Elevated uterine venous pressure further compromises flow Compensatory Mechanisms Blood bypasses compressed IVC Alternative venous return thru paravertebral epidural veins May be insufficient to prevent symptoms in some patients Clinical Manifestations: Hypotension; Pallor; Diaphoresis; Nausea and vomiting; Mental status changes Clinical Considerations Caution with vasodilating medications (volatiles, propofol) Care with neuraxial techniques that may further reduce venous return Primary treatment: Left uterine displacement or lateral decubitus position