Mechanisms of Hypervolemia Formation in Pregnant with Circulatory Failure

Lihachov V. K., Semenyuk L. N., Taranovskaya E. A., Dobrovolskaya L. N.,Yaremchuk L. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Pregnancy in women with acquired heart defects that are found in the 0.2­4.7 per cent of all pregnant women, often followed by circulatory failure. However, there are high levels of pre­eclampsia, delays of fetus development, abnormal labor activity, obstetric hemorrhages, maternal and perinatal mortality and others. In the formation of circulatory failure in these pregnant women play a significant role in the regulation violations volume and electrolytic balance with the influence of the changes in kidney as the main organ for volume and electrolytic regulation. However, the specific mechanisms of development inherent pregnant with circulatory failure of hypervolemia, are not well understood. The aim of the survey was to ascertain the specific mechanisms of formation of hypervolemia pregnant with circulatory failure occurred on the background of acquired heart defects. We examined 84 pregnant women with acquired heart diseases (32, 30 and 22 women without circulatory failure, with circulatory failure I degree and circulatory failure IIA degree respectively). The large majority of the surveyed (74 women) took place mitral heart disease rheumatic etiology (combined mitral defect with stenosis of the left ve­ nous eyes, combined mitral defect with mitral valve insufficiency, mitral valve insufficiency, mitral ­aortic disease). All of the surveyed women were inactive phase rheumatic process. Were studied in conditions of free dieresis: the kidney function (glomerular filtration by endogenous creatine, the tubular reabsorption), hormone levels influenc­ ing it (aldosterone and vasopressin in plasma by radioimmunology method), the volume of the circulating plasma with using Evans reactive with further deduction of circulating blood volume by the hematocrit level, the concentra­ tion of electrolytes in the plasma of blood and urine, stroke volume found echocardiography method by R. Popp, D. Harrison . In a result it was found that as the progression of heart failure in pregnant women through the primary lesion of the heart function progressive fall stroke and minute volume of blood (despite inherent in this state hypervolemia). Due to the decrease in cardiac output, on the one hand, a natural increases the total peripheral resistance of ves­ sels, and on the other, there is irritation volume receptions of high pressure zone (carotid sinus and wall aortic arch), what are high levels of vasopressin in the blood plasma. The increase of vascular tone causes a corresponding increase in the tone of the renal vessels, and through progressive decline in renal blood flow, leading to a decrease in glomerular filtration rate. The growing concentration of vasopressin levels causes the intensification reabsorption in the renal tubules; detained in the body water, relatively reducing concentration of sodium in the blood plasma, stimulates increased production of aldosterone. Increasing the concentration of aldosterone in plasma and urine contribute to the growth of tubular reabsorption of sodium. Unidirectional action hemodynamic mechanisms (vascular spasm, reduction of glomerular filtration of water and sodium) and hormonal (intensification of the tubular reabsorption of these substances) causing the delay fluid in the body of pregnant with circulatory failure. Detainees by kidneys water and salt cause the development of hy­ pervolemia. But this typical reaction of the kidneys, directed to the restoration of cardiac output, does not achieves goal through the primary lesion of the pumping function of the heart is able to pump blood vessels increased venous return blood. The results of this work have shown the need for further research to improve methods of treatment and preven­ tion of hemodynamic and volemical disorders during pregnancy.

pregnancy, circulatory failure, acquired heart diseases

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«Bulletin of problems biology and medicine» Issue 3 part 2 (111), 2014 year, 171-174 pages, index UDK 618. 3:616. 12­008