SUPINE HYPOTENSIVE SYNDROME IN DENTAL TREATMENT

Dr. Kapil Sharma
Department and institution: Assistant Professor Dept of oral and maxillofacial surgery Jodhpur Dental College

Dr. Jaya Pamboo
Department and institution: Lecturer Dept of , Oral Pathology Jodhpur Dental College

ABSTRACT

Supine hypotensive syndrome is characterized by severe supine symptoms and hypotension in late pregnancy, which compel the unconstrained subject to change position. Rarely, it may manifest even from the fifth month of pregnancy or postpartum, as well as in the pelvic tilt or sitting positions. Although inferior vena cava compression influenced primarily by the size of the uterus and exact maternal and fetal position, is the major determinant in its development, other factors may also be important in modulating the circulatory effects of such compression. As there seems to be a spectrum of severity from minimal central cardiovascular alterations to severe syncopal shock resulting from supine inferior vena cava compression, it is difficult to define a cutoff point at which the syndrome occurs. This syndrome is a major consideration in dental treatment of a pregnant patient.

Key words:- Supine Hypotension, Pregnancy, Syncope, Hypoxia

SUPINE HYPOTENSIVE SYNDROME IN DENTAL TREATMENT
INTRODUCTION

Supine hypotensive syndrome also called as aortocaval compression syndrome or maternal hypotension syndrome, is caused when the inferior vena cava is compressed by the weight of a pregnant female’s uterus, fetus, placenta and amniotic fluids while lying in the supine position. The effects of supine hypotensive syndrome are very similar to that of shock, but they are not treated in the same fashion.This condition can develop as early as the second trimester but is maximal during the third trimester, 36 to 38 weeks. When the pregnant female in these stages lies in the supine position, the added weight of the enlarged uterus and its contents will press down on the interior vena cava. The inferior vena cava is the route by which de-oxygenated blood from the lower half of the body returns to the heart. When the inferior vena cava is compressed it reduces the amount of blood that returns to the heart and reduces cardiac output, this can result in a loss of 30% of the effective circulating blood volume. It can take three to seven minutes for significant hypotension to become manifest.

Supine hypotensive syndrome can mimic symptoms of shock. This is because when the blood flow from the inferior vena cava is constricted the blood pressure will drop and will contract the uterine arteries and redirect blood to the major organs. This can cause distress for the fetus, where fetal hypoxia can occur and in extreme cases, fetal demise.This syndrome can be prevented by proper positioning of pregnant female.

SIGNS AND SYMPTOMS

• Pallor
• Signs of shock such as cool, moist and clammy skin
• Syncope or near syncope
• Tachycardia (early sign)
• Bradycardia (very late sign)
• Sweating
• Nausea
• Hypotension
• Dizziness
• Edema of the lower extremities
• Sings of fetal hypoxia or distress
• Decreased femoral pulse

DIAGRAMMATIC ILLUSTRATION OF INFERIOR VENA CAVA COMPRESSION BY GRAVID UTERUS