Experimental and Clinical Studies of Pregnant Hypertension Takashi SHIMAZU Department of Obstetrics and Gynecology, Osaka City University Medical Scho

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Transcription:

Experimental and Clinical Studies of Pregnant Hypertension Takashi SHIMAZU Department of Obstetrics and Gynecology, Osaka City University Medical School While the problem of late pregnant hypertension has been one of gravest concern to those specialized in obstetrics and perinatal care, the pathophysiologic aspect of the problem is yet to be clarified today. Proceeding under assumption that there is some casual relation between uterine wall and cavity from clinical observation that relatively high incidence of hypertension is seen among the primipara and women bearing twins and hydramnios, the author studied the relation between the hypertension of the pregnant women and uterine muscle tension. Utero-placental and renal cortical blood flow were measured by thermocouple method. The following experiments demonstrate that (1) intrauterine pressure in 148 cases of primigravidas and 74 cases of multigravidas tended to rise towards the onset of labor, with the mean blood pressure increasing in close relation to the intrauterine pressure, (2) the rise in intrauterine pressure caused byuterine contraction in 46 cases of pregnant rabbits, 19 cases of pregnant dogs and 2 cases of pregnant monkeys brought about a decrease in placental blood flow and at the same time, an increase in the systemic blood pressure, but it did not show any definite pattern in renal cortical blood flow, (3) the rise of intrauterine pressure with intraamniotic saline injection in 47 cases of pregnant animals gave rise to a decrease in the placental blood flow and at the same time, caused the renal cortical blood flow to drop and the systemic blood pressure to rise, respectively, (4) in 77 experiments in which catecholamine was admitted and in 7 cases, they were shivering at recovery for anesthesia, intrauterine pressure was noted to rise, and at the same time, placental and renal cortical blood flows were seen to decrease, the effect of catecholamine on the blood pressure and renal cortical blood flow were pronounced than that of the intraamniotic saline injection given to induce a passive uterine wall tension.

Fig. 1. Changes of maternal blood pressure during pregnancy.

Fig. 2. Changes of uterine resting tonus during pregnancy.

Fig. 3. Individual follow up of uterine resting tonus and blood pressure in 3-rd trimester of pregnancy. Fig. 4. Relationship between blood pressure and intrauterine pressure (amniotic fluid pressure) during uterine contraction induced by oxytocin.

Fig. 5. Correlation between per cent increase in intrauterine pressure and per cent increase in systemic blood pressure in 44 experimental cases of oxytocin administration (late pregnant women). Table 1. Influence of Uterine Contraction on the Maternal Hemodynamics in Pregnant Animals.

Fig. 6. Influence of uterine contraction on maternal blood pressure, placental blood flow, renal cortical blood flow and amniotic fluid pressure (pregnant monkey). Table II. Influence of Intraamniotic Saline Injecticn on the Maternal Hemodynamics in Pregnant Animals.

Fig. 8. Correlation between elevated intrauterine pressure by intraamniotic saline injection and per cent increase in systemic blood pressure in 24 experimental cases of intraamniotic saline injection (pregnant rabbits). Fig. 7. Influence of intraamniotic saline injection on maternal blood pressure, placental blood flow, renal cortical blood flow and amniotic fluid pressure (pregnant rabbit).

Fig. 9. Influence of intraamniotic saline injection on maternal blood pressure, placental blood flow, renal cortical blood flow and amniotic fluid pressure (pregnant monkey). Table III. Uteroplacental and Renal Hemodynamic Changes in the Condition of Induced Hypertension.

Fig. 10. Influence of intraamniotic saline injection or rapid drip intravenous infusion of 50ml saline on maternal blood pressure, placental blood flow, renal cortical blood flow and amniotic fluid pressure (pregnant rabbits). Fig. 11. Influence of shivering (recovering from anesthesia) on maternal blood pressure, placental blood flow, renal cortical blood flow and amniotic fluid pressure (pregnant dog).

Fig. 12. Influence of Neo-synesin(R) drip intravenous infusion on maternal blood pressure, placental blood flow, renal cortical blood flow and amniotic fluid pressure (pregnant dog).

Table IV. Comparison between the Influence of Intravenous Vasopressor Drip Infusion and Intraamniotic Saline Injection. Fig. 13. Recovering from deteriorating effects of noradrenaline on placental and renal cortical blood flow (pregnant rabbit).

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