Hypotensive syndrome in the mother. Hypotensive syndrome during pregnancy

Hypotensive syndrome during pregnancy, what is this pathology and how can it threaten the expectant mother and baby? Some women experience persistent low blood pressure during pregnancy. Hypotension is associated with headaches that are spasmodic in nature.

A woman gets tired very quickly, feels weak. Vomiting joins the attacks of headache. Against this background, a change of mood occurs very often. A similar complex of symptoms is observed in pregnant women between the ages of twenty-five and twenty-nine. There are many reasons for such a disease.

The reasons

With the appearance of this syndrome, the woman's condition, accompanied by toxicosis in the first trimester, is even more aggravated. Most often, these symptoms occur due to a fall. intracranial pressure. Head injuries can lead to such problems.

Less often, the pressure level decreases due to the outflow of cerebrospinal fluid. Cerebrospinal fluid loss can be caused by rupture of the meninges or fracture of the bones that form the skull.

There are special vascular plexuses in the brain. Their main task is the synthesis of cerebrospinal fluid and cerebrospinal fluid. Cerebrospinal fluid surrounds the spinal cord. For some reason, the choroid plexuses begin to produce their secret in much smaller quantities. Because of this, the pressure drops.

One of characteristic features hypotensive syndrome is the sudden onset of seizures. A woman may feel great when suddenly there is pain squeezing her head. Moreover, in the sitting position, the pain increases significantly.

The same thing happens if you raise your head sharply. If the head, on the contrary, is lowered, the pain will decrease slightly. An unpleasant moment is the appearance of nausea, and in some cases, the urge to vomit. One of the manifestations of the hypotensive syndrome is drowsiness, causeless mood swings.

Source: Davlenies.ru

Diagnostics

Only a doctor can diagnose a pathology after a comprehensive examination. The treatment of hypotensive syndrome in pregnant women is carried out by a neuropathologist or a neurosurgeon together with a gynecologist. A presumptive diagnosis is made on the basis of the patient's complaints and the collected anamnesis.

The main goal of the examination is to exclude other pathologies that have similar symptoms. Initially held general analysis blood and urine, and biochemical analysis blood from a vein. If necessary, cerebrospinal fluid is collected by puncture. If there is a history of skull injuries, an x-ray is taken. Finally, an MRI of the brain is performed.

If you have even a few symptoms, you should seek medical help. A woman will not be able to solve the problem on her own. In addition, the existing pregnancy imposes its limitations on the use of many drugs.

Even simple painkillers must be taken with caution, and only with the permission of the attending physician. It will be possible to carry out any treatment only after establishing the causes that caused the appearance of hypotensive syndrome in a pregnant woman.

Treatment

Treatment can be done in two ways. Using medications or by conducting surgical operation. Medical treatment reduced to the elimination of the main symptoms.

alkaloids

A group of alkaloids, which include "Caffeine" and "Securin". You should not take these drugs on your own, especially during pregnancy. The instructions for use have a special warning that this remedy during pregnancy is used only as directed by a doctor and with extreme caution.

Caffeine. Available in solution for injection and tablets. The form of treatment is chosen by the doctor. Active active substance this drug is caffeine-sodium benzoate. This drug has a stimulating effect on the central nervous system. In high doses, the drug can accumulate in tissues. Caffeine, which is part of the drug, differs from natural, although it is isolated from coffee beans and tea leaves.

This remedy improves mood, reduces fatigue. Pregnant patients are prescribed caffeine in small doses, since higher doses cause the opposite effect. Namely, they depress the nervous system. Small amounts of caffeine increase blood pressure.

To relieve headaches, the instruction recommends taking up to 100 mg. drug twice a day. But the final dose of the drug and the regimen in case of pregnancy is determined only by the attending physician. When taking tablets, it is forbidden to drink coffee and strong tea.

Co-administration of the drug with coffee will lead to an overdose of caffeine. The drug should be discontinued if any allergic reactions. Withdrawal from the drug should be gradual. Abrupt withdrawal of the drug may adversely affect the state of the nervous system.

Securin is available both in solution for injection and in tablets. This remedy stimulates the work of the brain and spinal cord. Its action resembles the effect on the body of a substance such as strychnine. But in this case, the effect on the body is weakened several times and the drug, unlike strychnine, is not toxic.

Tonic

This includes tinctures of ginseng, zamaniha, Chinese magnolia vine. No less effective preparations containing eleutherococcus extract. Ginseng tincture contains a number of biologically active substances, which have a positive effect on general state organism.

In combination, they stimulate the brain, but reduce, albeit slightly, the level of blood pressure. Additionally, they reduce fatigue and increase efficiency. This remedy should only be taken with the permission of a doctor.

The drug is taken only after breakfast. The dose is determined by the doctor. If the dosage is violated, sleep problems appear, the arterial pressure nosebleeds may occur. According to the instructions, the drug is not recommended for pregnant women, but in the case of hypotensive syndrome, this issue is decided by the doctor on an individual basis.

M-cholinolytics

This includes drugs such as Bellaspon and Atropine.

Bellaspon is available as a dragee. This drug has a sedative and antispasmodic effect. During pregnancy, it is not recommended for use, but in the presence of severe headaches, the issue of admission is decided by the attending physician. Self-medication is strictly prohibited. Apart from these drugs the patient is prescribed anabolic hormonal preparations, nootropics.

Surgical

Question about surgical treatment occurs if drug therapy not given positive result. This sometimes happens in the presence of a liquor fistula and with a defect in the dura mater of the brain. The operation is performed by a neurosurgeon. In the first case, the cerebrospinal fluid fistula is surgically closed. In the second case, plastic is performed with the replacement of the defect.

Hypotensive syndrome in the mother during pregnancy does not pose a danger to the life of a woman and a child. For all the time, not a single case of death associated with hypotensive syndrome has been identified. But the manifestations of the syndrome themselves are only the consequences of more serious deviations. Over time, it is these hidden processes in the body that can disrupt the normal functioning of many organs and systems.

According to statistics, hypertensive syndrome in pregnant women leads to complications and mortality in childbirth more often than any other diseases - per 100 births with complications of approximately 20-30 cases.

Hypertensive syndrome is the main cause of the risk of placental abruption and massive coagulopathic bleeding, can disrupt cerebral circulation, also a consequence of hypertension can be retinal detachment, eclampsia and HELLP syndrome.

Please note that hypertension can be controlled at the very beginning and during pregnancy the woman will not feel discomfort associated with it, but usually treatment does not affect the outcome of the birth itself.

How to identify hypertensive syndrome

First, an increase in blood pressure compared to blood pressure before pregnancy or blood pressure in the first trimester of pregnancy can indicate hypertension:

- systolic by 30 mm Hg or more.

- diastolic by 15 mm Hg or more.

Secondly, if a hypertensive syndrome is suspected, it is necessary to systematically measure blood pressure in a pregnant woman for 6 hours. BP above 140/90 mm. rt. Art., confirmed by several measurements in a row, will indicate that the pregnant woman still has hypertension.

Thirdly, by the calculation method, when the average blood pressure is equal to or more than 105 mm Hg, and the jumps in diastolic blood pressure exceed 90 mm Hg. Art.

Feel

The sensations are the same as those of hypertensive patients, only complicated by pregnancy. So from the most unpleasant can be called:

Breathing while walking

Flushing of the face, fever

Nocturnal spikes in blood pressure cause stomach cramps similar to hunger symptoms

Even sitting in a chair in front of the TV, you can feel how suddenly the heart, for no reason at all, goes astray

Lying on your back feeling short of breath

Headache often occurs, which seems to be nothing to provoke

In more later dates the child begins to beat too hard from a lack of oxygen and the very condition of the mother

Consequences for you

Depending on the form and severity of the hypertensive syndrome, the frequency of pressure surges, hypertension can lead to preeclampsia and eclampsia in childbirth. Also by the end of the term may be observed:

hyperreflexia

head sharp pain that does not go away after taking conventional analgesics

visual impairment, double vision

Yellowness of the skin

Pulmonary edema

Decreased diuresis and sudden swelling of the extremities.

After delivery, the hypertensive syndrome requires continued diagnosis and treatment so that hypertension does not become chronic disease for mother. Having missed such a moment, the doctor will pull the woman at the risk of being face to face with this unpleasant disease in subsequent births.

Consequences for the child

The main thing is preterm birth, when the baby has not yet gained enough body weight, and the lungs are not open enough. There is a high possibility of intrauterine death of the fetus, impaired blood supply to the brain, accelerated heartbeat, underdevelopment of the central nervous system, and so on.

Therefore, it is best to diagnose hypertension on early dates pregnancy and its moderate and severe forms should be treated during subsequent trimesters. This will enable the child to feel comfortable in the womb and avoid some of the serious consequences of this syndrome, and will also allow prolonging the gestational age to the required 38-40 weeks.

In the early stages, the doctor prescribes treatment depending on the severity of hypertension; in mild forms, it is sufficient to observe bed rest. With more severe forms ah, preeclampsia, prescribe magnesium therapy (intravenously or intramuscularly), as well as antihypertensive drugs. In the last trimester - hospitalization with constant bed rest; the choice of metaprolol, hydralazine, nifedipine, methyldopa - dopegyt, labetalol or nitroprusside; reduced sodium intake; use of diuretics, etc.

Dopegyt is usually prescribed as an antihypertensive drug, but a stronger drug may be prescribed at the discretion of the doctor.

In each individual case, the obstetrician-gynecologist develops an individual scheme for dealing with hypertensive syndrome. The best treatment delivery is considered, but, nevertheless, the doctor should try to delay this moment as close as possible to the normal terms of childbirth - at 38-40 weeks.

To be or not to be?

Knowing in advance about the presence of a hypertensive syndrome, it is difficult for a woman to make a decision about conception and a fully-term pregnancy. And even more so, such a decision is difficult to make the second, third time, when the first attempt was not particularly successful - the difficult first birth, especially with eclampsia, leaves its mark. In this case, consultations with a specialist are required, who will be able not only to prescribe treatment and manage the pregnancy, but also to support the woman morally during pregnancy, anticipating her fears.

Anamnesis. Heredity is not burdened. From childhood diseases suffered measles, chicken pox and diphtheria. An adult often suffers from tonsillitis and flu. menstrual function without features, the last menstruation was 12/1/1983. sex life from the age of 25, first marriage.
There was one pregnancy, which 2 years ago ended in an artificial abortion without complications. The second pregnancy is real.
the course of this pregnancy.There were no complications in the first half of pregnancy. Starting from the second half, the woman periodically began to experience weakness, especially in the supine position and with a long stay in an upright position. During the last 2 months she sleeps only on her side. Fetal movement was noted for the first time on December 3, 1983, 2 weeks ago - slight swelling on the legs. 2.3. the pregnant woman turned on her back in her sleep, after which she had a fainting state with a sharp decrease in blood pressure. The doctor was urgently called emergency care, who, according to the patient, made two injections of drugs that increase blood pressure. However, there was no pronounced effect. Only with a change in body position (the woman turned on her right side and maintained this position for 2 hours, these phenomena disappeared.
General and obstetric examination.Pregnant correct physique, satisfactory nutrition. The skin and visible mucous membranes are pink. There are swelling of the legs. Pulse 90 minutes, rhythmic, weak filling. BP 110/60 mm Hg From the side internal organs pathological changes not detected. Zhivo» ovoid shape, evenly increased in volume due to the pregnant uterus. The circumference of the abdomen at the level of the navel is 94 cm, the height of the uterus above the womb is 36 cm. The position of the fetus is longitudinal, cephalic presentation, first position, anterior view. The head is balloting over the entrance of the small pelvis. The fronto-occipital head size is 10.5 cm. The fetal heart rate is 136 per minute, rhythmic, to the left below the navel. The estimated weight of the fetus according to Rudakov is 3000 g. There is no labor activity, no water was poured out. Pelvic dimensions: 25, 28, 32, 20 cm. Solovyov's index 14 cm.
During an obstetric examination of a pregnant woman on the couch, she experienced a fainting state: she turned pale sharply, began to complain of a "lack of air", cold sweat appeared, her pulse increased to 120 per minute, and became weak filling. BP dropped to 70/40 mm Hg. The fetal heart rate increased to 150 per minute, but remained moose clear and rhythmic. When boiling urine, protein was found.

What is the diagnosis? What is the origin of this pathology? With what diseases should a differential diagnosis be made? How should a pregnant woman be treated?

Before us is a patient with a gestational age of 36 weeks, with symptoms of nephropathy (swelling of the legs, protein in the urine). However, the collaptoid condition that occurs in a woman with pronounced hypotension in the supine position deserves the most attention, which until recently was called the “compression syndrome of the inferior vena cava”. Currently, it has been given a more correct name - hypotensive syndrome of pregnant women in the supine position.

The pathogenesis of the syndrome is not yet well understood. Proponents of the vascular theory explain its origin as a violation of circulatory processes due to compression of the inferior vena cava by the pregnant uterus, which entails a decrease in blood flow to the right heart. However vascular therapy does not explain the complex genesis of the changes that occur, since with the same size of the uterus, the hypotensive syndrome develops only in some pregnant women, and its severity sometimes does not depend on the gestational age.

According to the neurogenic theory, this syndrome occurs in a reflex way due to irritation of the nerve plexuses and endings in the pregnant uterus. abdominal cavity. This theory is confirmed by observations when the phenomena of hypotension and collapse were significantly weakened or disappeared completely after the introduction of atropine into the pregnant woman or infiltration of the solar plexus with a novocaine solution.

Hypotensive syndrome is closely related to the hemodynamic features inherent in pregnancy. In pregnant women, unlike non-pregnant women, when moving from a vertical to a horizontal position, blood pressure almost always decreases significantly, which in the supine position does not have a pronounced tendency to recover.

Predisposing factors for the development of hypotensive syndrome include late toxicosis and hypotension. In late toxicosis with the presence of hypertension, a change in the position of the body of a pregnant woman, as a rule, is accompanied by more pronounced fluctuations in the maximum and minimum blood pressure, while the maximum pressure when the pregnant woman is lying on her back does not tend to return to the initial level.

In women with arterial hypotension, when they move from a vertical position to a horizontal one, the maximum pressure usually decreases more significantly, which is not immediately restored.

It is these features of vascular reactions that apparently underlie the more frequent occurrence of hypotensive syndrome in the supine position with late toxicosis and arterial hypotension.

It should be noted that the pregnant woman observed by us has signs of nephropathy (swelling of the legs, protein in the urine), but blood pressure is not increased and even rather somewhat reduced. Perhaps, before pregnancy, the woman suffered from arterial hypotension, which was not diagnosed. Along with this, it is known that nephropathy in the absence of arterial hypertension, especially against the background of previous hypotension, is accompanied by a significant lability of vascular tone. Against this background, hypotensive syndrome develops much more often in the supine position.

The clinical picture of this syndrome is quite characteristic. Usually, hemodynamic disorders occur in the position of the pregnant woman lying on her back and are expressed by motor restlessness, increased sweating, pallor skin, quickening or slowing of the pulse and a sharp decrease in blood pressure. In severe forms, vomiting and even short-term loss of consciousness are possible. The use in these pregnant women of various cardiac and vascular pharmacological preparations turns out to be ineffective, and only with a change in body position do these symptoms disappear. Just such clinical picture hypotensive syndrome is noted in the pregnant woman supervised by us.

With what diseases should a differential diagnosis be made?

Premature detachment of a normally located placenta usually occurs against the background of severe arterial hypertension due to the development of severe forms of late toxicosis of pregnant women, hypertension or nephritis. If detachment occurred over a significant extent of the placenta, then the disease begins with severe pain in the abdomen and uterine tension. The behavior of the pregnant woman is restless, she moans from pain, her pulse quickens significantly. With increasing internal (and external) bleeding, a picture of collapse and shock develops relatively quickly. An external obstetric examination makes it possible to establish the tension of the uterus, its soreness, especially pronounced in the area of ​​​​the location of the retroplacental hematoma. Sometimes there is asymmetry of the uterus, corresponding to the location of the placenta. Placental abruption, especially if it occurred in a significant area, quickly leads to intrauterine asphyxia and fetal death. The change in the position of the patient's body does not affect her general serious condition.

Uterine rupture during pregnancy is most often caused by anatomical inferiority of the uterine wall due to cicatricial changes (mainly after caesarean sections) or dystrophic processes that have developed as a result of complicated births or abortions. In the woman we observed, there are no indications in the anamnesis of these unfavorable moments. Threatening rupture of the uterus is characterized by restless behavior of the pregnant woman, abdominal pain and soreness of the uterus on palpation. Sometimes it is possible to identify local pain at the site of a future rupture of the uterine wall. With the beginning of uterine rupture, the described signs are joined bloody issues from the genital tract; intrauterine fetal asphyxia often develops. Changing the posture of the patient does not lead to the disappearance of these symptoms.

Eclampsia without seizures is one of the most severe forms of late toxicosis. It is characterized by typical signs of eclampsia (headaches, visual disturbances, pain in the epigastric region, high blood pressure, edema, oliguria, proteinuria, etc.) and the absence of convulsive seizures. It should be noted that at present, eclampsia, including its form without seizures, can occur against a background of relatively low blood pressure. The severity of the condition in eclampsia does not disappear due to a change in the position of the patient's body, as is the case with the hypotensive syndrome of pregnant women in the supine position.

How should a pregnant woman be treated?

By itself, the hypotensive syndrome does not require treatment. The pregnant woman is advised to avoid the supine position. However, the presence of concomitant nephropathy in her is an indication for hospitalization in the department (ward) of the pathology of pregnant women for required examination and treatment. Transportation of the patient should be carried out by gentle transport (ambulance) in the position on the side. The doctor or midwife of the antenatal clinic must accompany her.

Obstetric seminar, Kiryushchenkov A.P., Saburov H.S., 1992