Our Experience in Drug-Free Prevention of Bedridden Hypotensive Syndrome of Pregnant Women During Surgical Interventions Due to Primary Chronic Venous Disease Under Local Anesthesia

Abstract

Purpose Due to the increase in the number of non-obstetric surgical interventions during pregnancy under local anesthesia, surgeons have encountered such a pathology as supine hypotension syndrome of pregnancy (SHSP). This pathology was described by Howard R. et al. (1953). It occurs only in pregnant women, starting from the middle of the 11th and throughout the 111th trimester. It is manifested by a decrease in blood pressure (BP) in pregnant women by 30-40% from the baseline within 2-10 minutes with corresponding clinical manifestations on the part of both the pregnant woman and the fetus. The pathology occurs in patients mainly lying on their back, less often sitting. According to various authors, this pathology occurs in 20-70% of this contingent of patients, from latent forms to hypotonic shock. The task is to develop and actively implement for safe surgical intervention under local anesthesia the position of the pregnant woman on the operating table as one of the factors for the prevention of SHSP. Material and methods. The analysis was performed on the basis of 780 non-obstetric surgical interventions in pregnant women in the 11th and 111th trimesters under local anesthesia for primary symptomatic varicose veins of the lower extremities in the saphenous, non-saphenous vein basins and in combination. All pregnant women during the surgical intervention were placed on the operating table in the starting position lying on their back with the tabletop turned 30 0 to the left, with both lower limbs bent at the hip and knee joints by 120 0, with the head and chest raised by 30 0. In this position, for 2-3 minutes, we observe the dynamics of BP on the brachial arteries, pulse rate and the presence of clinical manifestations of SHSP. Result In 98.3% of the operated pregnant women, no manifestations of SHSP were noted. In 1.7%, mild manifestations of SHSP were noted, which required turning the table to 45 0, at which the BP stabilized to the initial limits with the absence of clinical symptoms in pregnant women with this pathology. Drug therapy support was not required. Conclusion. The proposed position of the pregnant woman on the operating table stabilized blood pressure by minimizing compression by the pregnant uterus of the terminal section of the abdominal aorta and/or the initial section of the inferior vena cava due to its mixing to the left, which improved hemodynamics in these areas. Such a position is comfortable for patients and the surgeon to perform a full surgical intervention with the observance of elements of antiseptics. The postoperative period in the operated patients proceeded without signs of disruption of the course of pregnancy and intrauterine development of the fetus. Such a position of the pregnant woman can be recommended in bed to preserve pregnancy and prevent SHSP.