PREDICTION OF POSSIBLE COMPLICATIONS IN WOMEN WITH IDIOPATHIC ARTERIAL HYPOTENSION DURING PREGNANCY AND DELIVERY
DOI:
https://doi.org/10.11603/24116-4944.2022.2.13452Keywords:
pregnancy, delivery, idiopathic arterial hypotensionAbstract
Although idiopathic arterial hypotension (IAH) is not included in the protocols for high-risk pregnant women, a report by the American College of Cardiology shows that the risk of cardiovascular disease increases logarithmically: from SBP levels <115 mm Hg. up to >180 mm Hg and from diastolic blood pressure levels <75 mm Hg. up to >105 mm Hg. And, while the main efforts of researchers are focused on arterial hypertension, then arterial hypotension attracts much less attention of scientists. The clinical significance of IAH in pregnant women is usually considered through the prism of the impact of this pathology on the state of the mother and fetus. On the another hand, the specific effect of pregnancy on systemic hemodynamics increases, "manifests" the main links of pathogenesis and clinical symptoms of IAH. The decrease in DBP from the first trimester of pregnancy and SBP and DBP in the second trimester was called the "pregnancy hypotensive phenomenon". Accordingly, a pregnancy, as a rule, intensifies the manifestations of hypotension that were present earlier and significantly worsens the quality of life of pregnant women with IAH. Numerous polymorphic complaints are formed under influence of the autonomic nervous system and indicate a vegetative imbalance in them. Changes in the central and peripheral hemodynamics of a woman with IAH (decrease in stroke volume and cardiac output, increase or decrease in vascular resistance) contribute to the slowing down of blood flow into the intervillous space of placenta with the formation of placental dysfunction and the development of fetal distress. Vegetative imbalance, especially the reduced tone of the sympathetic system, which is considered to be involved in the etiology of IAH, impairs the onset of labor, is a prerequisite to the deformation of the "labor dominant" and is one of the main reasons for the weakness of labor activity .The predominance of the tone of the parasympathetic nervous system contributes to the development of segmental spasm and dystocia of the cervix, which causes severe pain during labor and delayed opening of the cervix. Inadequate response to the ordinary and too extreme stimuli (one of which is delivery), manifests by tachycardia, regional spasm of blood vessels. As a consequence, there is a deterioration of the utero – placental blood flow and, thereby, particularly unfavorable conditions for the fetus are created. That is why women with IAH in delivery need thorough anesthesia and psychological support during delivery.
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