A pregnant woman at 36 weeks gestation is lying supine during a prenatal examination when she suddenly complains of dizziness, nausea, and feeling faint. Her blood pressure drops from 120/80 mmHg to 90/50 mmHg. What is the most appropriate immediate nursing intervention?

When a pregnant patient beyond 20 weeks gestation presents with sudden dizziness, nausea, or hypotension while supine, immediately suspect supine hypotensive syndrome. The primary mechanism is compression of the inferior vena cava by the gravid uterus, reducing preload and cardiac output.

• First-Line Intervention: Reposition the patient to the left lateral recumbent position. This action uses gravity to displace the uterus off the IVC, providing immediate relief of the obstruction. If left lateral is not possible, a right lateral position or manual displacement of the uterus to the left is an alternative.
• Avoid Supine Position: Never leave a patient in late pregnancy flat on her back for extended periods. During examinations or procedures, use a wedge under the right hip to achieve a pelvic tilt of at least 15 degrees.
• Monitoring: After repositioning, continuously monitor maternal vital signs (blood pressure, heart rate) and fetal heart rate. Blood pressure typically normalizes within minutes of relieving the compression.
• Adjunctive Measures: If hypotension persists despite lateral positioning, consider other causes such as hemorrhage. Administer oxygen and increase IV fluids as ordered, but only after the mechanical obstruction is addressed.

Key Safety Point: Repositioning is the definitive and most rapid treatment. Delaying this intervention while pursuing other measures (oxygen, fluids) prolongs fetal and maternal hypoperfusion.