Dirençli Postpartum Hipertansiyon ve Ödem Gelişiminde Artmış Tuz Duyarlılığı, Gözden Kaçan Bir Durum
Özet
Gebeliğin hipertansif hastalıkları hekimler tarafından özenle takip edilen bir konu iken postpartum hipertansiyon ve ödem takibi gözden kaçabilmektedir. Bunun en önemli sebebi gebeliğin hipertansif hastalıklarında ana tedavinin doğum eyleminin kendisi olmasıdır. Bu hastalıkların genel özelliği gebelerin kan basıncının postpartum 48. saate kadar düşmeye devam edip sonra tekrar yükselmesidir. Bu da erken taburculuk sonrası kan basıncı takiplerinin gözden kaçmasına neden olabilmektedir. Burada postpartum 10. haftaya kadar şiddetli baş ağrısı, kan basıncı yüksekliği ve ayaklarda ödemi olan hasta birden fazla kere polikliniğe başvurmuş ve bu sürecin lohusalığın normal süreci olduğu belirtilmiştir. Hastanın emzirmesi de göz önüne alınarak kalsiyum kanal blokörü ve loop diüretiği verildi. Tedavi sonrası baş ağrısı ve ödem azaldı sonrasında poliklinik takibine devam edildi. Gebeliğin hipertansif hastalıklarında ana patoloji plasental perfüzyonun azalması ve buna yanıt olarak salınan meditörlerin etkisiyle maternal endotelyal disfonksiyon gelişmesidir. Anjiojenik ve antianjiojenik imbalans arasındaki denge bozulur. Bu dengedeki bozukluk postpartum dönemde de devam edebilmektedir. Lohusalık dönemindeki bu patolojik süreç dirençli hipertansiyonun ve ödemin devam etmesinde en önemli faktör olan artmış tuz duyarlılığına neden olmaktadır. Gebelik sürecinde kazanılan volüm fazlalığı uzun süre devam edebilmektedir. Bundan dolayı da şiddetli semptomu ve bulguları olan hastalarda fazla beklenilmeden tedavi verilmelidir.
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