Presented is an investigation of the relationship of fetal heart rate (FHR) deceleration and

position of the patient in labor. In a group of 902 laboring patients, 126 (14%) demonstrated
late decelerations. Of the 126, 24 (19%) patients demonstrated late decelerations in the supine
position only. These occurred during uterine contractions and were associated with reduced
femoral arterial blood pressure and amplitude of the capillary pulse of the big toe. A drop in
capillary blood pH of the fetal scalp could also be demonstrated. These effects reproducibly
appeared and disappeared when supine and lateral positions were alternated. These data
would suggest that maternal aortic compression by the pregnant uterus plays a role in the
etiology of fetal stress as expressed by changes in fetal heart rate and acid base balance. This
effect can be evaluated and monitored simply by recording the pulse pressure of the big toe
and femoral arterial pressure. These atraumatic procedures can be applied to any patient.
(ObstetGynecol 65:481, 1985).

Relief of fetal distress by turning the laboring patient to the lateral position has been
attributed by Some authors to aortic compression by the pregnant uterus during uterine
contractions. The effect on the fetus of the aortic blood flow reduction resulting from
compression of the abdominal aorta by the pregnant uterus is studied. A method to estimate
this reduction has been reported. It was demonstrated that experimental constriction or
compression of the abdominal aorta in the pregnant monkey and in the pregnant dog
produced a parallel drop in the femoral artery pulse pressure and in the uterine artery blood
flow. These observations were extended to pregnant women by demonstrating a drop in
femoral artery pulse pressure when the patient was turned from the lateral to Supine
position, especially during uterine contraction; such a drop was not concomitantly observed
in the brachial artery blood pressure and was not observed after delivery. Therefore, when
the pregnant uterus presses.

From the Department of Obstetrics and Gynecology, Jamaica Hospital, Jamaica, New York.

VOL. 65, NO. 4, APRIL 1985

on the abdominal aorta, the resulting aortic blood flow reduction can be evaluated by
measuring the blood pressure or pulse pressure reduction in the femoral or popliteal artery.
This method is used in this study of the relationship between the blood flow reduction
produced by aortic compression and abnormal fetal heart rate patterns (FHR) during
continuous fetal electronic monitoring.

Materials and Methods

Using a fetal monitor (Corometrics' or Kontron"), external monitoring of both FHR and
uterine contractions was done when the uterine cervix was at an early stage of
dilatation and the membranes were intact; otherwise, at a later stage and with
ruptured membranes, fetal scalp electrodes, and intrauterine catheters were
preferred. Arteriosonde 1010, which combined an ultrasonic instrument and a cuff
transducer, was used to record the