Petit P, Top M, Chantraine F, Brichant J F, Dewandre P Y, Foidart J M
Maternité Universitaire, Hôpital de la Citadelle, Liège.
Rev Med Liege. 2009 Dec;64(12):620-5.
The four major hypertensive disorders related to pregnancy are preeclampsia, chronic hypertension, preeclampsia superimposed upon chronic hypertension, and gestational hypertension. The development of hypertension and proteinuria in pregnancy is usually due to preeclampsia, particularly in a primigravida. These findings typically become apparent in the latter part of the third trimester and progress until delivery, but some women develop symptoms in the latter half of the second trimester, or intrapartum, or the early postpartum period. Preeclampsia is characterized as mild or severe. Severe hypertension, coagulopathy, thrombocytopenia, liver function abnormalities, and fetal growth restriction are features of severe disease. Laboratory evaluation should assess haemoglobin/hematocrit and platelet count, renal and hepatic function, as well as assessment of fetal well-being and growth. Timing of delivery is based upon gestational age, maternal and fetal condition, and the severity of preeclampsia. Maternal end organ dysfunction and nonreassuring tests of fetal well-being are indications for delivery at any gestational age. Antihypertensive treatment aims at protecting the mother from severe hypertensive encephalopathy, but may jeopardize the fetus. We recommend antenatal corticosteroids (betamethasone) be given to women with preeclampsia at 26 to 34 weeks of gestation. Magnesium sulfate is more effective than phenytoin for prevention of eclamptic seizures.
与妊娠相关的四大高血压疾病是子痫前期、慢性高血压、慢性高血压并发子痫前期以及妊娠期高血压。妊娠期高血压和蛋白尿的发生通常归因于子痫前期，尤其是初产妇。这些表现通常在妊娠晚期较为明显，并持续进展直至分娩，但有些女性在妊娠中期后半期、产时或产后早期出现症状。子痫前期分为轻度和重度。重度高血压、凝血功能障碍、血小板减少、肝功能异常以及胎儿生长受限是重度子痫前期的特征。实验室评估应包括血红蛋白/血细胞比容和血小板计数、肝肾功能评估，以及胎儿健康和生长情况评估。分娩时机取决于孕周、母婴状况以及子痫前期的严重程度。母体终末器官功能障碍和胎儿健康状况不良是任何孕周都应分娩的指征。降压治疗旨在保护母亲免受严重高血压脑病的影响，但可能危及胎儿。我们建议对孕周在26至34周的子痫前期女性给予产前糖皮质激素（倍他米松）。硫酸镁预防子痫发作比苯妥英钠更有效。
