Exaggerated Supine Hypotension due to Red Degeneration of Fibroid Uterus during Pregnancy

Aortocaval compression syndrome manifested as supine hypotension is encountered after 20 weeks' gestation in pregnancy.When a pregnant woman lies down in the supine position, the inferior vena cava (IVC) and the aorta get compressed between the exaggerated lordotic curvature of the lumbar spine and the bulky uterus.This impedes the venous return, causing hemodynamic compromise manifested as hypotension.Red degeneration or carneous degeneration of uterine leiomyoma (uterine fibroid) is a well-known complication of uterine fibroid.As the pregnancy duration increases, the size of the fibroids increases and imposes an additional burden.Early identification of aortocaval compression and relieving the pressure of the gravid uterus on the IVC by displacement of gravid uterus is essential to prevent adverse consequences.The patient described in this report underwent lower segment cesarean section (LSCS).The enlarged gravid uterus due to large subserosal fibroid compressed the IVC, leading to hemodynamic compromise postoperatively after the delivery of the fetus.This was promptly identified and managed appropriately.