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Hypertension of the uterus
Last reviewed: 23.04.2024
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Hypertension of the uterus - this is not a disease, but a symptom, which means increased tension of the myometrium (smooth muscles of the uterus). Outside the pregnancy, the myometrium passes through various phases of contractile activity every month, which depends on the menstrual cycle.
This process is regulated by a variety of hormones and is provided by the autonomic nervous system, which responds to their signals and "conducts" the activity of all internal organs, the tone of the vessels and muscles.
But hypertension of the uterus during pregnancy is caused by other causes, because the functions of the uterus are commanded by other hormones. The frequency and intensity of the muscles of the uterus cause a natural anxiety in pregnant women, as this can be a harbinger of serious problems for both the future mother and the baby.
[Causes of hypertension of the uterus
The specific causes of hypertension of the uterus can be determined only on the basis of a survey of a pregnant woman. For this purpose, doctors prescribe a blood test for the level of hormones, for autoantibodies to phospholipids, antibodies to human chorionic gonadotropin (hCG), conduct ultrasound, etc.
It should be noted that in the absence of pregnancy, the contractile activity of the uterus also depends on the biosynthesis and action of hormones and prostaglandins, which cause contractions of the uterine muscles and the tearing off of its inner shell during menstruation.
But during pregnancy hormonal and neuroendocrine systems of a woman are reconstructed, and the development of many biologically active substances (including neurotransmitters of epinephrine and norepinephrine) decreases. In this case, the capacity of the uterus to contract is blocked by progesterone. This hormone not only ensures the introduction of the fetal egg in the endometrium, but also, in parallel, stimulates beta-adrenoreceptors of myometrium cells, resulting in relaxation of the smooth muscles of the uterus.
So in pregnancy, the tone of the uterus is controlled, so the main causes of hypertension of the uterus lie in the imbalance of hormones.
Hypertension of the uterus in the early stages is in many cases due to the fact that the ovaries of the woman produce too little progesterone. It can also be hyperandrogenism - excessive production of adrenal glands by male hormones. In addition, hypertension of the uterine wall in the initial period of gestation may indicate an alloimmune disorder, that is, when the mother's organism makes attempts to give an immune response to the presence of potentially alien protein cells of the embryo.
Among the most likely causes that cause hypertension of the uterus during pregnancy, experts also call: an abnormal form of the uterus; presence in the anamnesis of repeated abortions or operation on the uterus; endometriosis (pathological proliferation of the inner layer of the uterine wall); myoma (benign uterine tumor); multiple ovarian cysts; late toxicosis; diabetes mellitus, thyroid or adrenal gland problems; unhealthy habits (smoking, alcohol).
Hypertension of the uterus in the second trimester is often a consequence of autonomic dysfunction (in the form of increased tone of the sympathetic nervous system), disorders of fat metabolism, stress, excessive physical exertion, various inflammatory diseases of the genital area, and magnesium deficiency in the body. Because of the large size of the fetus, polyhydramnios, or if the woman is pregnant with twins, there may be hypertension of the uterus in the third trimester.
Although, as obstetrician-gynecologists say, after the 37-38th week of gestation, a periodic increase in the tone of the uterus is not considered pathology. Rather, on the contrary: there is a "training" of the uterus before childbirth. The fact is that by the end of pregnancy, the production of estrogen rises again, and this leads to the inevitable activation of the synthesis of oxytocin, the hormone of the hypothalamus. Before the birth, this hormone accumulates in the pituitary gland. First, oxytocin is necessary for the normal course of labor, as it stimulates the smooth muscles of the uterus and thereby contributes to its reduction. Secondly, this hormone, acting on the muscle cells of the breast, facilitates the flow of milk into the milk ducts.
What is dangerous for hypertension of the uterus?
Ipertonus of the uterus in the first trimester (before the 13th week) can lead to the death of the embryo and miscarriage.
Hypertensive uterus in the second trimester (before the 26th week) - a real threat of late spontaneous abortion. In addition, at such times, a frequent increase in the tone of the musculature of the uterus can cause persistent hypoxia of the fetus, which adversely affects its development. A hypertension of the uterus in the third trimester is fraught with premature onset of childbirth and the birth of a non-viable or premature baby. Or it can lead to so-called ischemic-cervical insufficiency - the inability of the cervix to keep its cavity closed while increasing the size of the fetus.
When there is a frequently recurring spontaneous local hypertension of the uterus, the threat of premature detachment (detachment) of the placenta from the mucous membrane of the uterus multiplies many times (as the placenta does not contract with uterine contraction). And if the third of the placenta exfoliates, the fetus may die. However, it should be borne in mind that a short-term spontaneous local hypertension of the uterus often occurs only when examining a pregnant woman or performing ultrasound.
Symptoms of hypertension of the uterus
The increase in tone differs in degree: hypertension of the uterus of 1 degree and hypertension of the uterus of the 2nd degree.
In the first case, doctors are referring to the partial hypertension of the anterior wall of the uterus or the hypertension of the posterior wall of the uterus, and in the second - the stress state of the miometrium of the entire uterus.
In most pregnant patients, the hypertension of the posterior wall of the uterus does not show itself by itself: the doctors detect a thickening of the muscle fibers on ultrasound. Although closer to the end of pregnancy there are painful sensations in the lumbar region, as well as drawing pain in the sacral area.
The main symptoms of the hypertension of the uterus, which affects its front wall, consist in a woman's tension in the abdomen (the stomach hardens); the symptom quickly passes in a prone position and with a calm deep breathing. There may be pulling pains in the lower abdomen, exciting crotch, as well as more frequent urination, rectal stress (similar to the urge to defecate).
The listed symptoms of hypertension of the uterus can have a different intensity, but most often resemble the condition before and during menstruation. Particular alarm and prompt treatment to the doctor should cause the appearance of any vaginal discharge, especially bloody.
Hypertonus of the lower segment of the uterus, that is, the cervix, during pregnancy (before the onset of the physiological period of labor) is practically not observed. Unless the neck was injured in previous births, or there is a significant deformation.
As a rule, it is the other way around: with the onset of pregnancy, the lower segment of the uterus becomes shorter, and its muscles - softer. But in the course of labor, with the rigidity of the cervix, hypertension of the lower segment of the uterus is quite possible.
Who to contact?
Treatment of hypertension of the uterus
Symptomatic treatment of uterus hypertension in pregnancy is to remove it with the help of appropriate pharmacological drugs. Also, therapy is carried out taking into account the etiology of this symptom complex.
How to treat hypertension of the uterus in the presence of a deficiency of endogenous progesterone? Drug treatment for hypertension of the uterus at early stages of pregnancy is caused by drugs containing hormones. Duphaston with hypertension of the uterus is appointed in this case by almost all domestic gynecologists. This drug (another trade name - Dydrogesterone) is a synthetic analog of the female sex hormone progesterone and promotes the preservation of pregnancy with its habitual miscarriage. The standard dosage is 20 mg per day (in two divided doses, according to the scheme prescribed by the doctor), the maximum dosage is 60 mg. However, it must be borne in mind that Dufaston has side effects in the form of headache, weakness, abdominal pain, breakthrough uterine bleeding.
What is prescribed for hypertension of the uterus? In the first place, drugs that relieve muscle spasms (spasmolytic). But-shpa with hypertension of the uterus - the most common appointment of obstetrician-gynecologists. The drug is well tolerated, side effects are rare and completely safe during the bearing of the child. But-spa (drotaverina hydrochloride) in tablets of 40 mg is given to adults one tablet three times a day. The maximum single dose of the drug is 80 mg, the daily dose is 240 mg.
What is prescribed for hypertension of the uterus, caused by a lack of magnesium? Of course, magnesium preparations. The lack of magnesium in the body is often noted during pregnancy and manifests itself with increased nervous excitability of the cells - muscle spasms and convulsions. Magnesium helps to restore the electrolyte neutrality of smooth muscle cells, significantly reduces the excitability of cellular neurons and normalizes the transmission of sympathetic nervous system impulses.
It was found that the intake of magnesium preparations by pregnant women from 4-5 to 24-25 weeks of gestation reduces the risk of abortion by more than 60%, and the threat of premature births - by almost a third.
In hospital conditions, magnesium sulphate or Magnesia with uterine hypertension is widely used. The drug in the form of 20-25% solution of magnesium sulfate is administered parenterally (intramuscularly) for 5-10-20 ml. The exact dosage and duration of treatment are determined by the doctor.
For oral administration, tablets are recommended: magnesium citrate, magnesium gluconate, magnesium orotate or magnesium lactate. Most magnesium in magnesium lactate is 48 mg in a tablet 0.5 g. The daily dose is about 50 mmol. Frequency and duration of admission the doctor sets individually. With renal impairment, this drug is prescribed with caution.
To remove hypertension of the uterus during pregnancy, Magne B6 (Magnelis B6) is prescribed. The drug is taken 1-2 tablets three times a day (while eating, drinking a glass of liquid). Side effects of Magne-B6 can be expressed in the form of pain in the epigastric region, constipation, nausea, vomiting and flatulence. It should be noted that magnesium reduces the level of iron absorption and can lead to anemia.
What can not with hypertension of the uterus?
If during pregnancy the tone of the uterus systematically rises, then to keep the fetus pregnant woman can not: physically tense (including in terms of everyday household matters); to lift heavy; walk or stand for a long time; to undertake automobile trips for considerable distances; fly by the plane; take a bath (or too hot a shower).
The concepts of sex and hypertension of the uterus are incompatible, so for some time you will have to do without intimacy: increased uterine contraction during intercourse can lead to premature termination of pregnancy.