Accessible Requires Authentication Published by De Gruyter November 16, 2013

Risk of inferior vena cava compression syndrome during fetal MRI in the supine position – a retrospective analysis

Daniela Kienzl, Vanessa Berger-Kulemann, Gregor Kasprian, Peter C. Brugger, Michael Weber, Dieter Bettelheim, Franz Pusch and Daniela Prayer


Objectives: Inferior vena cava compression syndrome (VCCS) is a serious complication of supine fetal magnetic resonance imaging (MRI) examinations, particularly during late gestation. This morphologic study correlated the occurrence of VCCS with the grade of inferior vena cava (IVC) compression.

Materials and methods: There were 56 fetal MRI in the supine position [median gestational weeks (GW) 27+4] and 16 fetal MRI in the lateral position (median GW 30+6) retrospectively analyzed. The grade of maternal IVC compression was determined by the maximal anterior-posterior diameter (DAP) at the level of L4/L5. Fetal head position and right-sided uterus volume were analyzed. Clinical VCCS-related symptoms during fetal MRI were assessed.

Results: A noncompressed IVC was present in 1.8% (n=1) and a DAP of 5 to <10 mm in 33.3% (n=19) and 1 to <5 mm in 64.9% (n=36). The DAP was independent of fetal head position (P=0.99) and showed no significant correlation with gestational age (r=0.33). IVC compression increased with right-sided uterus volume (r=–0.328; P=0.014). There was a significant difference in DAP in the lateral position compared with the supine position (P<0.001). Clinical assessment revealed no symptoms of VCCS in any woman.

Conclusions: The presented data support the concept of physiologic compensation for significantly reduced venous backflow in the supine position during the second and third trimesters of pregnancy.

Corresponding author: Daniela Kienzl, Department of Radiology and Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria, E-mail:


[1] Brugger PC, Prayer D. Actual imaging time in fetal MRI. Eur J Radiol. 2012;81:e194–6. Search in Google Scholar

[2] Brugger PC, Stuhr F, Lindner C, Prayer D. Fetal magnetic resonance imaging: methods and techniques. Radiologe. 2006;46:105–11. Search in Google Scholar

[3] Brugger PC, Stuhr F, Lindner C, Prayer D. Methods of fetal MR: beyond T2-weighted imaging. Eur J Radiol. 2006;57:172–81. Search in Google Scholar

[4] Guihard-Costa AM, Menez F, Delezoide AL. Organ weights in human fetuses after formalin fixation: standards by gestational age and body weight. Pediatr Dev Pathol. 2002;5:559–78. Search in Google Scholar

[5] Guihard-Costa AM, Papiernik E, Grange G, Richard A. Gender differences in neonatal subcutaneous fat store in late gestation in relation to maternal weight gain. Ann Hum Biol. 2002;29: 26–36. Search in Google Scholar

[6] Hirabayashi Y, Shimizu R, Fukuda H, Saitoh K, Igarashi T. Effects of the pregnant uterus on the extradural venous plexus in the supine and lateral positions, as determined by magnetic resonance imaging. Br J Anaesth. 1997;78:317–9. Search in Google Scholar

[7] Holmes F. The supine hypotensive syndrome. 1960. Anaesthesia. 1995;50:972–7. Search in Google Scholar

[8] Ikeda T, Ohbuchi H, Ikenoue T, Mori N. Maternal cerebral hemodynamics in the supine hypotensive syndrome. Obstet Gynecol. 1992;79:27–31. Search in Google Scholar

[9] Kerr MG. Clinical implications of inferior vena caval occlusion in pregnancy. Proc R Soc Med. 1964;57:705–6. Search in Google Scholar

[10] Kiefer RT, Ploppa A, Dieterich HJ. Aortocaval compression syndrome. Anaesthesia. 2003;52:1073–83; quiz 1084. Search in Google Scholar

[11] Kimura BJ, Dalugdugan R, Gilcrease 3rd GW, Phan JN, Showalter BK, Wolfson T. The effect of breathing manner on inferior vena caval diameter. Eur J Echocardiogr. 2011;12:120–3. Search in Google Scholar

[12] Kinsella SM. Lateral tilt for pregnant women: why 15 degrees? Anaesthesia. 2003;58:835–6. Search in Google Scholar

[13] Kinsella SM, Lohmann G. Supine hypotensive syndrome. Obstet Gynecol. 1994;83:774–88. Search in Google Scholar

[14] Kinsella SM, Lee A, Spencer JA. Maternal and fetal effects of the supine and pelvic tilt positions in late pregnancy. Eur J Obstet Gynecol Reprod Biol. 1990;36:11–7. Search in Google Scholar

[15] Kuo CD, Chen GY, Yang MJ, Tsai YS. The effect of position on autonomic nervous activity in late pregnancy. Anaesthesia. 1997;52:1161–5. Search in Google Scholar

[16] Leithner K, Pornbacher S, Assem-Hilger E, Krampl E, Ponocny-Seliger E, Prayer D. Psychological reactions in women undergoing fetal magnetic resonance imaging. Obstet Gynecol. 2008;111:396–402. Search in Google Scholar

[17] Ryo E, Okai T, Kozuma S, Kobayashi K, Kikuchi A, Taketani Y. Influence of compression of the inferior vena cava in the late second trimester on uterine and umbilical artery blood flow. Int J Gynaecol Obstet. 1996;55:213–8. Search in Google Scholar

[18] Schefold JC, Storm C, Bercker S, Pschowski R, Oppert M, Kruger A, et al. Inferior vena cava diameter correlates with invasive hemodynamic measures in mechanically ventilated intensive care unit patients with sepsis. J Emerg Med. 2010;38:632–7. Search in Google Scholar

[19] Scott DB, Kerr MG. Inferior vena caval pressure in late pregnancy. J Obstet Gynaecol Br Commonw. 1963;70:1044–9. Search in Google Scholar

[20] Wright L. Postural hypotension in late pregnancy. “The supine hypotensive syndrome”. Br Med J. 1962;1:760–2. Search in Google Scholar

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2013-7-23
Accepted: 2013-10-8
Published Online: 2013-11-16
Published in Print: 2014-5-1

©2014 by Walter de Gruyter Berlin Boston