Anaphylaxis in Pregnancy — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementAnaphylaxis in PregnancyORE Part 1

A dental patient at 28 weeks' gestation develops anaphylaxis with circulatory compromise. While emergency treatment is started, which position is most appropriate?

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Correct answer: C — Left lateral position

The correct answer is C. At 28 weeks, supine positioning can allow the gravid uterus to compress the inferior vena cava and aorta, reducing venous return and cardiac output. This compounds the vasodilatation and hypotension of anaphylaxis. UK anaphylaxis guidance advises that pregnant patients lie on their left side to prevent aortocaval compression. A supine position may sometimes be required for airway management or CPR, but then manual left uterine displacement is required; it is not the preferred position here. Sitting upright may worsen circulatory collapse, while the right lateral position does not provide the recommended uterine displacement. A head-down position is not the primary positioning intervention and may impair respiratory management.

Reference: Resuscitation Council UK, Emergency treatment of anaphylaxis, section 4.7 "Anaphylaxis during pregnancy", May 2021. https://rightdecisions.scot.nhs.uk/media/2910/emergency-treatment-of-anaphylaxis-may-2021_0.pdf