Brichant G, Dewandre P Y, Foidart J M, Brichant J F
Department of Obstetrics & Gynaecology, Liège University Hospital, Belgium.
Acta Clin Belg. 2010 May-Jun;65(3):163-9. doi: 10.1179/acb.2010.035.
Features of severe preeclampsia include severe proteinuric hypertension and symptoms of central nervous system dysfunction, hepatocellular injury, thrombocytopenia, oliguria, pulmonary oedema, cerebrovascular accident and severe intrauterine growth restriction. Women with severe preeclampsia must be hospitalized to confirm the diagnosis, to assess the severity of the disease, to monitor the progression of the disease and to try to stabilize the disease. Severe preeclampsia may be managed expectantly, in selected cases. The objective of expectant management in these patients is to improve neonatal outcome. Expectant management is based on antihypertensive treatment and prevention of end organ dysfunction. Antihypertensive treatment improves maternal outcome but has the potential to be deleterious for the foetus. Plasma volume expansion has been suggested for severe preeclampsia but trials failed to show any benefit. Magnesium sulfate is the anticonvulsivant of choice to treat or prevent eclampsia when indicated. Antenatal corticosteroids are recommended in severely preeclamptic women with 26-34 weeks gestation. Timing of delivery is based upon gestational age, severity of preeclampsia, maternal and foetal risks.
重度子痫前期的特征包括重度蛋白尿性高血压以及中枢神经系统功能障碍、肝细胞损伤、血小板减少、少尿、肺水肿、脑血管意外和严重胎儿生长受限等症状。重度子痫前期患者必须住院，以确诊病情、评估疾病严重程度、监测疾病进展并努力使病情稳定。在某些特定情况下，重度子痫前期可采取期待治疗。对这些患者进行期待治疗的目的是改善新生儿结局。期待治疗基于降压治疗和预防终末器官功能障碍。降压治疗可改善孕产妇结局，但可能对胎儿有害。曾有人建议对重度子痫前期患者进行扩容治疗，但试验未能显示出任何益处。硫酸镁是在有指征时用于治疗或预防子痫的首选抗惊厥药物。对于妊娠26 - 34周的重度子痫前期孕妇，建议使用产前糖皮质激素。分娩时机取决于孕周、子痫前期的严重程度、孕产妇和胎儿风险。
