SYNCOPE IN PREGNANCY: INTERDISCIPLINARY RISK ASSESSMENT, DIFFERENTIAL DIAGNOSIS AND CLINICAL OBSERVATIONS
Main Article Content
Abstract
Transient loss of consciousness during pregnancy is often attributed to physiological gestational adaptation, orthostatic hypotension, vasovagal reaction, anemia or inferior vena cava compression. This interpretation is acceptable only after clinically significant cardiac, neurological, thromboembolic and obstetric causes have been excluded.
Aim – to systematize causes of syncope in pregnancy, identify high-risk features and propose an interdisciplinary model for initial clinical assessment.
Materials and methods. A narrative literature review was combined with clinical systematization and analysis of anonymized clinical observations. Publications on syncope guidelines, syncope in pregnancy, arrhythmias, orthostatic intolerance, POTS, pulmonary embolism, cardiovascular disease in pregnancy and mimics of neurological paroxysms were analyzed.
Results. The same clinical manifestation – transient loss of consciousness – may have different mechanisms and prognostic significance in pregnant patients. A three-domain expert model focused on cardiovascular, neurological and uteroplacental risks is proposed. A preliminary clinical alertness scale is introduced for initial triage; it is not a validated diagnostic instrument and requires prospective assessment.
Conclusion. Syncope in pregnancy should be considered not as an independent diagnosis, but as a clinical event requiring explanation of its mechanism and assessment of maternal, neurological and fetoplacental risk.
Keywords
Article Details
Information about financing and conflict of interests
The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article.
This work is licensed under a Creative Commons Attribution 4.0 License.
How to Cite
References
1. Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the Diagnosis and Management of Syncope. Eur Heart J. 2018; 39(21): 1883-1948. doi: 10.1093/eurheartj/ehy037
2. 2018 ESC Guidelines for the diagnosis and management of syncope. Russian Journal of Cardiology. 2019; 24(7): 130-194. Russian (Рекомендации ЕОК по диагностике и лечению синкопальных состояний 2018 //Российский кардиологический журнал. 2019. Т. 24. № 7. С. 130-194.) doi: 10.15829/1560-4071-2019-7-130-194
3. Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope. Circulation. 2017; 136(5): e60-e122. doi: 10.1161/CIR.0000000000000499
4. De Backer J, Haugaa KH, Hasselberg NE, de Hosson M, Brida M, Castelletti S, et al. 2025 ESC Guidelines for the Management of Cardiovascular Disease and Pregnancy. Eur Heart J. 2025; 46(43): 4462-4568. doi: 10.1093/eurheartj/ehaf193
5. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cifkova R, De Bonis M, et al. 2018 ESC Guidelines for the Management of Cardiovascular Diseases During Pregnancy. Eur Heart J. 2018; 39(34): 3165-3241. doi: 10.1093/eurheartj/ehy340
6. Chatur S, Islam S, Moore LE, Sandhu RK, Sheldon RS, Kaul P. Incidence of Syncope During Pregnancy: Temporal Trends and Outcomes. J Am Heart Assoc. 2019; 8(10): e011608. doi: 10.1161/JAHA.118.011608
7. Javier RC, Singh PV, Shrestha J, Abdalla R, Narang P, Patel H, et al. Trends and Immediate Outcomes of Syncope During Pregnancy: A Narrative Review. Cureus. 2023; 15(12): e49833. doi: 10.7759/cureus.49833
8. Orenshtein S, Sheiner E, Sergienko R, Wainstock T. Syncope in Pregnancy, Immediate Pregnancy Outcomes, and Offspring Long-Term Neurologic Health. Am J Obstet Gynecol MFM. 2023; 5(12): 101190. doi: 10.1016/j.ajogmf.2023.101190
9. Kotov AS, Firsov KV. Reflex asystolic syncope: clinical lecture. RMZh. 2023; 31(3): 31-34. Russian (Котов А.С., Фирсов К.В. Рефлекторные асистолические синкопе (клиническая лекция) //РМЖ. 2023. Т.31, № 3. С. 31-34.)
10. Yarusi BB, Jagadeesan VS, Schimmel DR. Not for the Faint of Heart: A Rapidly Evolving Case of Syncope During Pregnancy. Circulation. 2020; 142(5): 501-506. doi: 10.1161/CIRCULATIONAHA.120.046795
11. Agrawal A, Works-Fleming F, Isiadinso I, Ogunniyi MO. Syncope in a Pregnant Woman: Infiltrative Cardiomyopathy and Presumed Cardiac Sarcoidosis. JACC Case Rep. 2020; 2(1): 101-106. doi: 10.1016/j.jaccas.2019.12.005
12. Bauersachs J, König T, van der Meer P, Petrie MC, Hilfiker-Kleiner D, Mbakwem A, et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail. 2019;21(7):827-843. doi: 10.1002/ejhf.1493
13. Joglar JA, Kapa S, Saarel EV, Dubin AM, Gorenek B, Hameed AB, et al. 2023 HRS Expert Consensus Statement on the Management of Arrhythmias During Pregnancy. Heart Rhythm. 2023; 20(10): e175-e264. doi: 10.1016/j.hrthm.2023.05.017
14. Tamirisa KP, Oliveros E, Paulraj S, Mares AC, Volgman AS. An Overview of Arrhythmias in Pregnancy. Methodist Debakey Cardiovasc J. 2024; 20(2): 36-50. doi: 10.14797/mdcvj.1325
15. Manolis TA, Manolis AA, Apostolopoulos EJ, Papatheou D, Melita H, Manolis AS. Cardiac Arrhythmias in Pregnant Women: Need for Mother and Offspring Protection. Curr Med Res Opin. 2020; 36(7): 1225-1243. doi: 10.1080/03007995.2020.1762555
16. Terekhovskaya YuV, Smirnova EA. Cardiac arrhythmias in pregnant women. Eruditio Juvenium. 2017; 5(3): 462-480. Russian (Тереховская Ю.В., Смирнова Е.А. Нарушения ритма сердца у беременных //Наука молодых. 2017. Т. 5, № 3. С. 462-480.) doi: 10.23888/HMJ20173462-480
17. Kirgizova MA, Dedkova AA, Kisteneva IV, Borisova EV, Popov SV. Influence of rhythm and conduction disorders on pregnancy course and outcome. Russian Journal of Cardiology. 2019;(7):7-11. Russian (Киргизова М.А., Дедкова А.А., Кистенева И.В., Борисова Е.В., Попов С.В. Оценка влияния нарушений ритма и проводимости сердца на течение и исход беременности: опыт аритмологического центра //Российский кардиологический журнал. 2019. № 7. С. 7-11.) doi: 10.15829/1560-4071-2019-7-7-11
18. Useinova RKh, Sulima AN, Rybalka AN, Beglitse DA, Rumyantseva ZS, Baskakov PN, et al. Modern view on the etiopathogenesis of heart rhythm disorders and methods of their correction in pregnant women. Obstetrics, Gynecology and Reproduction. 2021; 15(4): 419-429. Russian (Усеинова Р.Х., Сулима А.Н., Рыбалка А.Н., Беглице Д.А., Румянцева З.С., Баскаков П.Н., и др. Современный взгляд на этиопатогенез нарушений ритма сердца у женщин в период беременности и методы их коррекции //Акушерство, Гинекология и Репродукция. 2021. Т. 15, № 4. С. 419-429.) doi: 10.17749/2313-7347/ob.gyn.rep.2021.226
19. ACOG Practice Bulletin No. 196: Thromboembolism in Pregnancy. Obstet Gynecol. 2018; 132(1): e1-e17. doi: 10.1097/AOG.0000000000002706
20. Robert-Ebadi H, Le Gal G, Righini M. Diagnosis of Pulmonary Embolism During Pregnancy. J Clin Med. 2022; 11(15): 4586. doi: 10.3390/jcm11154586
21. Makowska A, Treumann T, Venturini S, Christ M. Pulmonary Embolism in Pregnancy: A Review for Clinical Practitioners. J Clin Med. 2024; 13(10): 2863. doi: 10.3390/jcm13102863
22. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism. Eur Heart J. 2020; 41(4): 543-603. doi: 10.1093/eurheartj/ehz405
23. Kamata M, Maruyama T, Nishiguchi T, Iwasaki S. Sudden Onset of Syncope and Disseminated Intravascular Coagulation at 14 Weeks of Pregnancy: A Case Report. BMC Pregnancy Childbirth. 2020; 20: 406. doi: 10.1186/s12884-020-03083-8
24. Morgan K, Smith A, Blitshteyn S. POTS and Pregnancy: A Review of Literature and Recommendations for Evaluation and Treatment. Int J Womens Health. 2022; 14: 1831-1847. doi: 10.2147/IJWH.S366667
25. Bourne KM, Nerenberg KA, Stiles LE, Shibao CA, Okamoto LE, Garland EM, et al. Symptoms of Postural Orthostatic Tachycardia Syndrome in Pregnancy: A Cross-sectional, Community-based Survey. BJOG. 2023; 130(9): 1120-1127. doi: 10.1111/1471-0528.17437