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[子痫前期孕妇的妊娠终止标准]

[Criteria of pregnancy termination in women with preeclampsia].

作者信息

Haddad B, Masson C, Deis S, Touboul C, Kayem G

机构信息

Service de gynecologie-obstetrique, CHI Créteil, université Paris-XII, 40, avenue de Verdun, 94010 Créteil cedex, France.

出版信息

Ann Fr Anesth Reanim. 2010 Apr;29(4):e59-68. doi: 10.1016/j.annfar.2010.02.019. Epub 2010 Mar 27.

Abstract

Few studies establishing clear criteria for the medical interruption of a pregnancy complicated by PE are available today. Most of these studies are either retrospective or observational. When combining an analysis of the available literature together with the experts' opinions, one can propose the following set of criteria for therapeutic interruption of pregnancy in the setting of PE, which apply mainly for the severe forms of the disease. These criteria can be subdivided into maternal and fetal criteria. Maternal criteria are a severe uncontrollable HT, eclampsia, acute pulmonary edema, retro placental haematoma, oligura (<100 ml in 4 hours) resistant to appropriate fluid expansion, persistent signs of imminent eclampsia (headache or visual disturbances), persistent epigastric pain, HELLP syndrome, new-onset renal failure and a gestation time within the first 24 weeks. The fetal criteria are prolonged and variable fetal heart rate (FHR) decelerations, a short term variability in FHR <3 bpm, a Manning score < or =4 on two separate occasions, severe oligohydramnios, an estimated fetal weight below the 5(th) percentile beyond the 32(nd) week of amenorrhea and an inverted diastolic flow in the umbilical artery beyond the 32(nd) week of amenorrhea. In case of non-severe PE beyond the 36(th) week of amenorrhea, interruption of the pregnancy must be considered.

摘要

目前,很少有研究为因肺栓塞(PE)而并发的妊娠进行医学干预制定明确标准。这些研究大多是回顾性或观察性的。综合现有文献分析与专家意见,可提出以下一组适用于PE情况下治疗性终止妊娠的标准,主要适用于该疾病的严重形式。这些标准可细分为母体标准和胎儿标准。母体标准包括严重难以控制的高血压(HT)、子痫、急性肺水肿、胎盘后血肿、经适当扩容后仍存在少尿(4小时内<100毫升)、持续存在即将发生子痫的体征(头痛或视觉障碍)、持续上腹部疼痛、HELLP综合征、新发肾衰竭以及妊娠在24周内。胎儿标准包括延长且变异的胎儿心率(FHR)减速、FHR短期变异<3次/分钟、两次单独检查时曼宁评分≤4分、严重羊水过少、停经32周后估计胎儿体重低于第5百分位数以及停经32周后脐动脉舒张期血流倒置。对于停经36周后非严重PE的情况,必须考虑终止妊娠。

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