Angiopathy with hypertension syndrome and pregnancy. Angiopathy of the retina during pregnancy - a characteristic of the condition

Angiopathy of the retina during pregnancy has some features compared to its course in an ordinary person. The main manifestations in the development of late toxicosis are the variance of narrowing in the arteries, there is also a tendency to stop spasms along with the cessation of toxicosis. In addition, in pregnant women there is a rapid reverse formation of changes in the fundus, that is, the pathology is characterized by rapid self-restoration of the fundus and complete restoration of the visual organs after childbirth and with the support of various therapeutic methods, if they are effective against toxicosis.

Predictions of changes in the visual organs during the development of toxicosis in pregnant women are considered favorable compared with similar cases in other patients.

Contraindications to continue pregnancy

Particular attention should be paid to the assessment of changes in the retina in relation to abortion. Experts hold different points of view. All known contraindications to the continuation of gestation are divided into relative and absolute.

Absolute contraindications include:

1. Angiopathy of the retinal vessels during pregnancy, accompanied by retinal detachment with late toxicosis, but only on condition that it correlates with toxicosis, and was not caused by myopia.
2. Hypertensive form of retinopathy.
3. Arteriospastic retinopathy, accompanied by hemorrhages.
4. Thrombosis in the central vein.

Relative contraindications include:

1. Initial changes in arteriospasmodic retinopathy, accompanied by mild hemorrhages.
2. previously transferred pathologies of the retina against the background of late toxicosis in the expectant mother during previous pregnancies - retinal detachment, retinopathy.

Naturally, with relative contraindications, a woman should be under the strict supervision of the attending physician and ophthalmologist.

Characteristics of angiopathy in pregnant women

Retinal angiopathy during pregnancy differs from other cases of pathology in ordinary people. With the manifestation of late toxicosis, the hallmarks of the lesion are:

• Uncharacteristic for vessels in the retina sclerosis.
• Variable narrowing of the lumen of the arteries, which can be restored after the cessation of toxicosis.
• Rare cases of impaired blood flow due to the formation of obstruction in the lumen of the vessels.
• Rapid recovery - partial or complete - of the vessels in the fundus, as well as the restoration of the work of the visual organs after the birth of a child and special sparing therapy, which involves the treatment of toxicosis.

The main danger of the disease during pregnancy is the risk that the vessels may burst during childbirth due to their contraction during contractions. This situation can provoke a partial and, with a strong complication, a complete loss of vision. In this regard, angiopathy becomes the main indication for the organization of a caesarean section - this procedure completely eliminates any load on the retinal vessels. Natural childbirth is only allowed if there is a low chance of vascular rupture. Indications for the implementation of a caesarean section are established by an ophthalmologist.

After the completion of childbirth, another diagnosis of the state of the vessels of the eye is required. Angiopathy indicates that vascular disorders are characteristic of the whole organism. When visiting an ophthalmologist, you can track the dynamics of violations or improvements. Usually, any symptoms go away after the baby is born.

In case of unfavorable results, the patient is prescribed a course of therapy. It is important to remember that during pregnancy and breastfeeding, it is forbidden to take any medicines.

Implementation of diagnostic measures

Diagnosis of a pathological condition during pregnancy is carried out in the same way as with other types of angiopathy. The patient's complaints are collected, a physical examination, percussion, auscultation and palpation are implemented.

Sometimes the doctor decides to use ultrasound techniques, angiography or computed tomography.

Providing effective treatment during pregnancy

Angiopathy of the retina in pregnancy is very undesirable, because the body in this state is already under severe stress due to the heavy load and cardinal changes.

It is better not to start treatment of the disease if it is not characterized by a severe course. When starting, the doctor should consider all the pros and cons, but it is better not to implement drug therapy, because during pregnancy this can affect the health of the unborn child. Specialists try to avoid prescribing drugs that normalize blood flow in the vessels of the eyeball, which are usually prescribed to every sick person.

If it is impossible to avoid taking drugs, then it is better to prescribe a reception in the process of the second half of bearing a child. Preference is given primarily to gentle methods, such as physiotherapy. The exception is severe forms of angiopathy, which provoke more complex consequences.

Predictions of the course and treatment of the disease

Angiopathy during pregnancy has a much more favorable prognosis compared to the development of this pathology in an ordinary person, for example, in hypertensive patients, etc.

In most situations for pregnant women, the disease is a temporary side effect that causes abnormalities in the woman's body. But do not neglect this violation, it is important to get advice and advice from your doctor.

Angiospasm of the retina can lie in wait for any person, because this is not a separate disease, but a symptom that can manifest itself in various pathologies.

For one reason or another, the ability of the vascular wall to adapt to changes in blood pressure is impaired. This can occur both due to damage to the structure of the wall itself, and due to a disorder of the nervous and humoral regulation. As a result, spasm of the vessels of the eye leads to dysfunction of the local blood flow and malnutrition of the retina.

How does this happen

The development of a persistent and uncontrolled contraction of the smooth muscle layer of the vascular wall is based on a violation of ion transport. A small amount of Na +, K + causes erratic contractions, and an increased amount of Ca2 + - an increase in the tone of muscle fibers.

Angiospasm of the retinal vessels looks like a narrowing of the inner diameter of the artery due to prolonged contraction of the smooth muscle layer in its walls. Spasmodic contraction may not last long, but its consequences are quite unfavorable for the retina. Periodic oxygen starvation leads to the formation of edema in the spasm zone, weakening of the walls of blood vessels, impaired blood circulation, ischemia of the retinal tissue, its stroke and loss of vision.

Spasm of the vessels of the eye is the result of freezing of the body, severe pain, exposure to chemicals (carbon sulphide compounds and lead are especially dangerous), hypertension, late toxicosis of pregnant women, Raynaud's syndrome, diabetes, vascular atherosclerosis, inflammation, thrombus.

Most often, angiospasm of the retina of both eyes indicates a disorder of the nervous regulation of tone.

Diagnostic signs

The usual symptoms of a sharp narrowing of the vessels of a spasmodic nature are "flies" before the eyes, transient blurred vision. As a rule, this can last for several minutes, but in the presence of persistent spasm of the central artery, visual impairment remains permanent.

If an ophthalmoscopy is performed during spasms, then the fundus may have characteristic signs of malnutrition. His vessels look sharply constricted, and the optic disc and the vascular floor itself are pale, with a waxy tinge. After the cessation of the attack, these structures return to normal.

The role of high blood pressure

The reaction of the fundus vessels is usually due to general diseases of the cardiovascular system. Most often, the lesion occurs according to the hypertensive type, when arterial hypertension or hypertension occurs.

In this case, the increase in pressure does not have absolute values ​​and is individual for each individual. Even a slight rise in indicators disrupts microcirculation, causes hypertrophy of the muscular layer of blood vessels, local spasm of arterioles, congestion in venous vessels, and a decrease in blood flow velocity in the capillary network.

Usually, the picture of the fundus is one of the reliable diagnostic criteria for hypertension. The nature and extent of vascular damage help to establish the stage of the disease and track its dynamics.

In addition to cardiovascular, angiospasm of the retina may have other ways of development.

• Unreasonably strong vasoconstriction can also occur in diseases of the brain and central nervous system that affect the vasomotor center.
• In the event of a head injury, the arteries may respond reflexively by narrowing to prevent bleeding.
• Also, the cause of a violation of vascular tone can be a psycho-emotional state of stress, a period of hormonal adjustment - pregnancy, menopause, adolescence.
• Endocrine disorders - excess thyroid-stimulating hormone, diabetes mellitus.

fundus picture

Spasms of arteries with simultaneous expansion of venous vessels are characteristic of the first stage of hypertension. The uneven contraction causes a different caliber along the course of the arteries and gives them a tortuous appearance.

These phenomena are exacerbated in the second stage of hypertension. Persistent spasm of the arteries gives way to their sclerosis followed by complete obliteration of the vessel. The altered artery, when crossing with a vein, exerts a certain pressure on it, causing the latter to sag a little. So there is another ophthalmic sign of hypertension - arteriovenous chiasm. Tortuosity and obstruction of blood flow during vasospasm contribute to blood stasis and thrombosis, significantly increasing the risk of retinal hemorrhages.

The last stage of the underlying disease for the retina proceeds in the form of angioretinopathy and neuroretinopathy. Violation of blood circulation in a state of angiospasm leads to hemorrhages, swelling of the retina and optic nerve papilla. A so-called "star" is formed around the macula from small foci of damage. At the level of subjective perception, a person may notice a change in visual fields, a decrease in its sharpness, sensitivity to light and twilight vision.

Treatment

After it becomes clear what it is - angiospasm, the tactics of its treatment also emerge.

The underlying disease gives symptoms in different organs and systems

The main thing is to treat the underlying disease and only under the guidance of a qualified doctor. If a spasm of the fundus vessels is observed against the background of eclampsia, severe poisoning, then emergency medical care will be needed in a hospital setting.

Symptomatically, to eliminate vasospasm and its consequences, drugs are used that provide:

• Vasodilating or antispasmodic effect. These are calcium antagonists (Nifedipine, Amlodipine) and drugs based on herbal ingredients - periwinkle (Cavinton), ginkgo biloba (Tanakan). Preparations, which are chemically based on nicotinic acid, expand small capillaries especially well (Nikospan, Nicotinic acid, Acipimox).
• Dehydrating - diuretics, removing excess fluid, reduce blood pressure and remove the increased reflex resistance of the walls of blood vessels (hydrochlorothiazide).
• Improving the rheological properties of blood - anticoagulants and antiaggregants. They act by improving blood flow and preventing the development of blood clots or thromboembolism in constricted vessels (Aspirin, Ticlopidin, Curantil, Trental). Anticoagulants improve microcirculation (Warfarin, Fraxiparine).

The elimination of spasm episodes involves not only the treatment of the disease that caused it, but also general preventive measures: avoiding stress, proper rest of the organs of vision, quitting smoking and alcohol, good nutrition, moderate exercise, regular visits to an ophthalmologist, cardiologist, neuropathologist.

The development of hypertensive angiopathy of the retina in pregnant women usually occurs not earlier than 6 months, and 90% of all cases occur in the last month. The disease can occur both in those who are expecting the birth of a child for the first time, and during repeated pregnancy.

Features of retinal angiopathy during pregnancy

Angiopathy of the retina during pregnancy differs from the hypertensive form of the disease. The characteristic signs of late toxicosis are:

• intermittent, changeable narrowing of the arteries, passing after the cessation of toxicosis;
• unusual sclerosis of the blood vessels of the retina;
• circulatory disorders in the vessels of the retina (due to narrowing of the vascular lumen) is extremely rare;
• restoration of the vessels of the fundus and vision (complete or almost complete) occurs quickly after childbirth or therapeutic measures for the treatment of toxicosis.

The main danger associated with angiopathy during pregnancy is the likelihood of rupture of retinal vessels during contractions during natural childbirth. The consequence of this may be a partial or complete loss of vision, so angiopathy is considered an indication for a caesarean section, which avoids stress on the vessels of the retina. If the chance of vascular rupture is low, natural childbirth is possible. Indications for a caesarean section are determined by an ophthalmologist.

After childbirth, a re-examination of the state of the retinal vessels is mandatory. The manifestation of angiopathy indicates problems with blood vessels throughout the body. Regular visits to the ophthalmologist, allows you to observe the dynamics of the ongoing changes. After childbirth, as a rule, all symptoms disappear.

If the result of the study is unsatisfactory, a course of treatment is prescribed. It is necessary to know that during pregnancy and lactation it is highly undesirable to take any medications.

Diagnostics

Angiopathy of the retina during pregnancy is diagnosed similarly to other types of this disease. Diagnosis includes: history taking, physical examination, percussion, auscultation and palpation. If necessary, it is possible to carry out ultrasound, magnetic resonance imaging, fundus angiography or computed tomography.

Treatment

Carrying out drug treatment of angiopathy during pregnancy is undesirable, since this may affect the development and health of the fetus. Because of this, doctors avoid the use of drugs to improve blood circulation, which are usually used to treat angiopathy, and use softer methods, such as physiotherapy. An exceptional case is the presence of a severe form of angiopathy, which threatens with serious consequences.

Forecast

With angiopathy of the retina during toxicosis in pregnant women, the prognosis is much more favorable than with the hypertensive form of this disease. Most often, this is a passing "side effect" of the changes that occur during this period in a woman's body.

The period of bearing a child for the female body is the most difficult stage, during which there is a powerful hormonal restructuring of all organs and systems. It must be understood that as the fetus grows, the volume of blood in the mother's body increases. This is necessary to provide the embryo with all the nutrients and oxygen. Against the background of this change, the vascular walls become more elastic and extensible. This is where the danger of retinal angiopathy during pregnancy lies. In the event that a woman has any form of weakness of the vascular wall, then unforeseen complications may develop. Most often, during pregnancy, the development of pathology is diagnosed in relation to one or both eyes. During pregnancy, this is a temporary phenomenon that resolves on its own without third-party intervention in almost 90% of diagnosed cases.

Why is this condition dangerous?

However, this condition is dangerous because there is always a risk of rupture of a blood vessel that cannot cope with the increased blood flow. In this case, both hemorrhage in the eye can occur, and more serious consequences can occur. For example, in pregnant women, a minor degree of primary detachment often develops. Moreover, the main factor in the development of this pathology is precisely the nervous and mental overstrain, as a result of which the background of arterial pressure changes, which is invariably reflected in the state of the vessels of the eye. With a calm pregnancy, angiopathy of the retina can be dangerous in the birth period. If labor activity is too violent and the woman's body is experiencing overload, then bleeding in the tissue of the eye may develop. In order to exclude this possibility, obstetricians, based on the opinion of an ophthalmologist, recommend a birth resolution to the expectant mother using a caesarean section.

Symptoms of retinal angiopathy during pregnancy and diagnosis

Diagnosis of retinal angiopathy during pregnancy is usually carried out by a hardware method of visual examination of the fundus. This procedure is prescribed to all pregnant women without exception in strict accordance with the standards of medical examination. The specialist sees dilated blood vessels that are not able to contract on their own. The tissues surrounding them may be blurred and swollen due to congestion. Symptoms of retinal angiopathy during pregnancy can manifest as:

• sensations of pain in the eyes;
• feeling of slight pressure on the eyeball;
• decrease in visual acuity;
• recurrent headaches;
• appearance of the red-eye effect.

If such signs appear, you should visit an ophthalmologist and undergo the examination proposed by him.

Is it necessary to treat retinal angiopathy during pregnancy?

Currently, conservative therapy for retinal angiopathy consists in taking sufficiently strong angioprotectors. These drugs can have a negative effect on the state of the embryo. In particular, a sharp narrowing of the blood vessels reduces the amount of oxygen that reaches the fetus. This can lead to intrauterine hypoxia and death of the baby. That is why, whether it is necessary to treat retinal angiopathy during pregnancy, the attending physician of each patient decides individually. In this regard, observational tactics are chosen during the period of bearing a child. A woman is registered with a dispensary and a specialist periodically checks the condition of the vessels of the retina. Independent childbirth is prohibited. A caesarean section is performed. Until the moment of childbirth, it is necessary to ensure psychological and physical rest. Treatment of retinal angiopathy is carried out as needed after resolution of pregnancy.

Angiopathy of the retina is diagnosed in pregnant women more often in the last trimester. The essence of the pathology is that due to the increase in the volume of blood necessary to supply the placenta and the growing fetus, a large load is placed on the vessels: their expansion is observed, a violation of blood flow with the ensuing consequences. The doctor must detect the pathology in time and prescribe effective methods of prevention.

If it is not possible to normalize the state of the eye vessels, the question of delivery by caesarean section will be raised.

Why is it developing?

The main factors that affect the development of the disease during pregnancy are:

• late toxicosis;
• hypertension, even if there was no pathology before pregnancy.

If, before conception, a woman was diagnosed with one of the conditions, such as diabetes mellitus, arterial hypertension, osteochondrosis of the neck, nervous diseases with impaired vascular tone, trauma to the head, upper chest, the risk of developing retinal angiopathy is higher. Experts note that a pathological change in the vessels of the retina during pregnancy is a fairly common problem provoked by hormonal changes in the body. With the right approach, it passes after the birth of the baby.

Symptoms

The appearance of dots before the eyes and blurred vision of objects are symptoms of the disease.

The first symptoms can be noticed as early as the 6th month, but in 90% of cases retinal angiopathy during pregnancy is determined in the last weeks. Symptoms of angiopathy in women in position are as follows:

• decrease in visual acuity;
• fog or dots before the eyes;
• pain and cramps;
• pulsation and dryness of the mucosa.

Diagnostics

To determine the pathology of the retina in a pregnant woman, a consultation with an ophthalmologist is necessary. The doctor examines the eyeball, examines the history and complaints of the patient. Not all standard diagnostic methods are suitable for a woman in position, therefore, the doctor often makes a diagnosis on the basis of a physical and computer examination, ultrasound with duplex and Doppler scanning of the vascular plexuses of the retina.

If angiopathy has developed against the background of intoxication due to late toxicosis, the obstetrician-gynecologist may prescribe additional research methods, for example, testing, in order to identify indirect causes that could provoke retinal blood supply disorders. A blood test is carried out for general indicators, sugar, coagulability, PTI and fibrinogen.