Bicornuate uterus and aortocaval compression.

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology

Background:

• Supine hypotensive syndrome (SHS) is a common complication during pregnancy, caused by aortocaval compression.
• A bicornuate uterus is a congenital uterine anomaly that can lead to various obstetric complications.

Observation:

• A patient with a bicornuate uterus experienced a severe episode of supine hypotensive syndrome.
• Standard left lateral tilt positioning failed to resolve the syndrome, suggesting atypical anatomical factors.

Findings:

• The failure of left lateral tilt was attributed to the rightward anatomical displacement of the bicornuate uterus.
• This displacement likely exacerbated aortocaval compression, rendering the standard maneuver ineffective.

Implications:

• Clinicians should consider right lateral tilt in cases of SHS unresponsive to left tilt, especially in patients with uterine anomalies.
• Awareness of uterine anatomy is critical for managing SHS effectively during pregnancy and surgical procedures.