Shainker Scott A, Edlow Jonathan A, O'Brien Karen
Gynecology and Reproductive Biology, Harvard Medical School, Clinical Fellow, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Medicine Harvard Medical School, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.
Best Pract Res Clin Obstet Gynaecol. 2015 Jul;29(5):721-31. doi: 10.1016/j.bpobgyn.2015.03.004. Epub 2015 Mar 16.
Caring for pregnant and postpartum patients with neurological disease carries specific challenges. In performing a diagnosis, it is often difficult to differentiate between true pathology and neurological symptoms resulting from normal pregnancy physiology. Treating the pregnant patient can be problematic as well. Providers need to be aware of the possible untoward effects of maternal treatments on the developing fetus, but not withhold therapies that reduce disease-related morbidity and mortality. Given the complexities of conducting trials during pregnancy, few treatments are based on high-quality data; observational data and clinical expert opinion often guide treatments. With the exception of preeclampsia/eclampsia, neurological diseases typically do not warrant early delivery in the absence of fetal distress. Multidisciplinary care, utilizing the expertise of anesthesiology, critical care medicine, emergency medicine, maternal-fetal medicine, neurology, and radiology, is essential in ensuring prompt diagnosis and treatment.
照料患有神经系统疾病的孕妇和产后患者面临着特殊的挑战。在进行诊断时,往往很难区分真正的病理状况与正常妊娠生理导致的神经症状。治疗孕妇也可能存在问题。医疗服务提供者需要意识到母体治疗对发育中胎儿可能产生的不良影响,但也不能拒绝使用能降低疾病相关发病率和死亡率的疗法。鉴于孕期开展试验的复杂性,很少有治疗方法是基于高质量数据的;观察性数据和临床专家意见常常指导治疗。除子痫前期/子痫外,在没有胎儿窘迫的情况下,神经系统疾病通常不需要提前分娩。利用麻醉学、重症医学、急诊医学、母胎医学、神经病学和放射学等专业知识进行多学科护理,对于确保及时诊断和治疗至关重要。