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优化子痫前期的分娩策略:痫性发作管理和分娩方式的综合综述。

Optimizing Delivery Strategies in Eclampsia: A Comprehensive Review on Seizure Management and Birth Methods.

机构信息

Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin, Poland.

Department of Health Promotion - Chair of Nursing Development, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland.

出版信息

Med Sci Monit. 2023 Oct 7;29:e941709. doi: 10.12659/MSM.941709.


DOI:10.12659/MSM.941709
PMID:37803822
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10566307/
Abstract

Eclampsia seizure is an always serious and potentially fatal obstetric condition. Safe delivery in women with pregnancies complicated by eclampsia seizures is still one of the greatest challenges in perinatal medicine. Pregnancy should be terminated (childbirth) in the safest and least traumatic way possible. Attempting vaginal delivery can take place only exceptionally, in the event of possibly quick completion of childbirth with a stable state of the mother and the fetus. However, immediate labor via cesarean section is most often recommended. It is essential to maintain left lateral patient positioning during cesarean section. Regional anesthesia can be used only in conscious patients who are free from coagulopathy and from HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome to decrease the risk of aspiration and failed intubation attempts in preeclamptic or eclamptic women. For sudden, unexpected interventions, when a patient arrives at the hospital with an eclampsia seizure without lab results, general anesthesia can be the best option and should be performed by an experienced medical team of anesthesiologists, ready to perform difficult intubation. Magnesium sulfate is the drug that should be used first to stop eclamptic convulsions and prevent their recurrence. Intravenous antihypertensive drugs can stabilize elevated blood pressure (BP), preventing multiorgan failure and recurrent eclampsia seizure, and thus the prevention of maternal death. This article aims to review the management of seizures during pregnancy in women with eclampsia to ensure safe delivery.

摘要

子痫发作是一种始终严重且潜在致命的产科病症。在患有子痫发作的孕妇中安全分娩仍然是围产期医学中最大的挑战之一。应尽可能以最安全和创伤最小的方式终止妊娠(分娩)。只有在母亲和胎儿状态稳定且分娩可能迅速完成的情况下,才能例外尝试阴道分娩。然而,通常建议立即行剖宫产术。在剖宫产过程中,保持患者左侧卧位至关重要。只有在意识清醒、无凝血功能障碍且无 HELLP(溶血、肝酶升高和血小板计数降低)综合征的患者中才能使用区域麻醉,以降低子痫或子痫前期妇女发生误吸和气管插管失败的风险。对于突然、意外的干预,当子痫发作的患者未经实验室检查就到达医院时,全身麻醉可能是最佳选择,应由经验丰富的麻醉医生医疗团队进行,以便随时进行困难的气管插管。硫酸镁是首先用于停止子痫发作和预防其复发的药物。静脉内降压药物可稳定血压升高,防止多器官衰竭和再次发生子痫发作,从而预防产妇死亡。本文旨在回顾子痫发作期间的孕妇管理,以确保安全分娩。

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[2]
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[3]
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本文引用的文献

[1]
Eclampsia: A Critical Pregnancy Complication Demanding Enhanced Maternal Care: A Review.

Med Sci Monit. 2023-7-7

[2]
Eclampsia and Its Treatment Modalities: A Review Article.

Cureus. 2022-9-12

[3]
The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice.

Pregnancy Hypertens. 2022-3

[4]
Gestational Hypertension and Preeclampsia: An Overview of National and International Guidelines.

Obstet Gynecol Surv. 2021-10

[5]
What's New in Neuraxial Labor Analgesia.

Curr Anesthesiol Rep. 2021

[6]
Duration of postpartum magnesium sulfate for seizure prophylaxis in women with preeclampsia: a systematic review and meta-analysis.

J Matern Fetal Neonatal Med. 2022-12

[7]
Neuropathophysiology of preeclampsia and eclampsia: A review of cerebral hemodynamic principles in hypertensive disorders of pregnancy.

Pregnancy Hypertens. 2021-3

[8]
The impact of pre-eclampsia definitions on the identification of adverse outcome risk in hypertensive pregnancy - analyses from the CHIPS trial (Control of Hypertension in Pregnancy Study).

BJOG. 2021-7

[9]
Eclampsia in the 21st century.

Am J Obstet Gynecol. 2022-2

[10]
Prevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines.

Curr Hypertens Rep. 2020-8-27

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