Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA.
Am J Obstet Gynecol. 2022 Feb;226(2S):S1211-S1221. doi: 10.1016/j.ajog.2020.10.027. Epub 2021 Jul 7.
High blood pressure in the postpartum period is most commonly seen in women with antenatal hypertensive disorders, but it can develop de novo in the postpartum time frame. Whether postpartum preeclampsia or eclampsia represents a separate entity from preeclampsia or eclampsia with antepartum onset is unclear. Although definitions vary, the diagnosis of postpartum preeclampsia should be considered in women with new-onset hypertension 48 hours to 6 weeks after delivery. New-onset postpartum preeclampsia is an understudied disease entity with few evidence-based guidelines to guide diagnosis and management. We propose that new-onset hypertension with the presence of any severe features (including severely elevated blood pressure in women with no history of hypertension) be referred to as postpartum preeclampsia after exclusion of other etiologies to facilitate recognition and timely management. Older maternal age, black race, maternal obesity, and cesarean delivery are all associated with a higher risk of postpartum preeclampsia. Most women with delayed-onset postpartum preeclampsia present within the first 7 to 10 days after delivery, most frequently with neurologic symptoms, typically headache. The cornerstones of treatment include the use of antihypertensive agents, magnesium, and diuresis. Postpartum preeclampsia may be associated with a higher risk of maternal morbidity than preeclampsia with antepartum onset, yet it remains an understudied disease process. Future research should focus on the pathophysiology and specific risk factors. A better understanding is imperative for patient care and counseling and anticipatory guidance before hospital discharge and is important for the reduction of maternal morbidity and mortality in the postpartum period.
产后高血压最常见于产前患有高血压疾病的女性，但也可在产后新出现。产后子痫前期或子痫是否代表与产前发病的子痫前期或子痫不同的实体尚不清楚。虽然定义有所不同，但在分娩后 48 小时至 6 周内新出现高血压的女性中，应考虑诊断为产后子痫前期。新出现的产后子痫前期是一种研究不足的疾病实体，缺乏基于证据的指南来指导诊断和管理。我们建议，对于新出现的高血压伴有任何严重特征（包括既往无高血压病史的女性血压严重升高），在排除其他病因后，将其称为产后子痫前期，以促进识别和及时管理。产妇年龄较大、黑人种族、产妇肥胖和剖宫产均与产后子痫前期的风险增加相关。大多数迟发性产后子痫前期患者在分娩后 7 至 10 天内出现，最常见的症状是神经系统症状，通常是头痛。治疗的基石包括使用降压药、镁和利尿剂。与产前发病的子痫前期相比，产后子痫前期可能与更高的产妇发病率相关，但它仍然是一种研究不足的疾病过程。未来的研究应侧重于病理生理学和特定的危险因素。为了患者的护理和咨询以及出院前的预期指导，更好地了解疾病是至关重要的，这对于减少产后产妇发病率和死亡率至关重要。
