How should women with evidence of hypoxaemia who are more than 20 weeks pregnant be managed?

For women who are more than 20 weeks pregnant and show signs of hypoxaemia, the left lateral tilt is the preferred management position. This positioning is crucial because, during pregnancy, the enlarging uterus can compress the inferior vena cava when the patient is in a supine position. This compression can lead to decreased venous return to the heart and result in reduced cardiac output and worsened oxygenation.

By placing the patient in the left lateral tilt position, the weight of the uterus is shifted off the inferior vena cava, promoting better blood flow back to the heart and enhancing oxygen delivery to both the mother and fetus. This position also helps to optimize respiratory function and reduce the risk of further hypoxaemia.

Other positions, such as sitting upright or supine, do not effectively alleviate the pressure on the major blood vessels as the left lateral tilt does. Consequently, the left lateral tilt is a safe and effective strategy for managing hypoxaemia in pregnant women, ensuring both maternal comfort and fetal well-being.