Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Sinai Health SystemUniversity of Toronto Toronto Canada.
Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine University of Washington Medical Center Seattle WA.
J Am Heart Assoc. 2022 Apr 5;11(7):e023694. doi: 10.1161/JAHA.121.023694. Epub 2022 Mar 14.
Hypertensive disorders of pregnancy are among the most serious conditions that pregnancy care providers face; however, little attention has been paid to the concept of tailoring clinical care to reduce associated adverse maternal and perinatal outcomes based on the underlying disease pathogenesis. This narrative review discusses the integration of phenotype-based clinical strategies in the management of high-risk pregnant patients that are currently not common clinical practice: real-time placental growth factor testing at Mount Sinai Hospital, Toronto and noninvasive hemodynamic monitoring to guide antihypertensive therapy at the University of Washington Medical Center, Seattle. Future work should focus on promoting more widespread integration of these novel strategies into obstetric care to improve outcomes of pregnancies at high risk of adverse maternal-fetal outcomes from these complications of pregnancy.
妊娠高血压疾病是妊娠保健提供者面临的最严重的疾病之一；然而，基于潜在的疾病发病机制，针对减少相关不良母婴围产结局的临床护理定制问题，尚未得到足够的重视。本综述讨论了将基于表型的临床策略整合到高危孕妇管理中的问题，目前这还不是常规临床实践：西奈山医院（多伦多）的实时胎盘生长因子检测和华盛顿大学医学中心（西雅图）的无创血流动力学监测以指导降压治疗。未来的工作应重点推动将这些新策略更广泛地纳入产科护理，以改善高危妊娠母婴结局不良的妊娠的结局。
