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妊娠高血压的病理生理学与当代管理策略:一篇叙述性综述

Pregnancy-Induced Hypertension Pathophysiology and Contemporary Management Strategies: A Narrative Review.

作者信息

Agarwal Garima S, Agrawal Anil K, Singhal Daksh, Bawiskar Dushyant, Shedge Saylee S

机构信息

Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.

Psychiatry, Raja Rajeshwari Medical College, Bangalore, IND.

出版信息

Cureus. 2024 Jul 6;16(7):e63961. doi: 10.7759/cureus.63961. eCollection 2024 Jul.

Abstract

In the case of PIH, the history is the story of gradually developing awareness and the gradual formation of requisite knowledge. The development of the sphygmomanometer, or blood pressure cuff, in the late 1700s, provided the basis for modern systematic blood pressure reporting for Gravid patients. In the following years and over a few decades, the relationship between high blood pressure and these complications, such as preeclampsia and eclampsia, became clearer. The hypertensive disease was categorized by the American Committee on Maternal Welfare in 1952, which included PIH, chronic hypertension, and preeclampsia. Today, attention is being paid to the identification of such factors, the search for ways to enhance the treatment of diseases, methods for their diagnosis, and the enhancement of pregnancy outcomes. Pregnancy can cause high blood pressure in two of the following ways: preeclampsia and gestational hypertension. These conditions are both part of something called pregnancy-induced hypertension (PIH). In the world, most problems for moms and babies during pregnancy come from PIH. To help both mom and baby, we need to know a lot about what causes it, how to manage it, and how to watch the baby carefully. Aspects like immune responses, the environment, and genes all mix to cause PIH. They make the placenta not work right. When the cells that help the placenta grow don't do their job well, when blood vessels are stiff, when there's too much stress on the body, or when there's not a good balance of chemicals that help build blood vessels, things can get bad. Blood vessels all over the body squeeze tight, blood flow goes down, and blood pressure goes up. That can make a lot of organs stop working right and stop the baby from healthy growth. Various studies concluded that PIH severely limits the blood flow to the placenta and thus contributes to reduced fetal growth. It showed that compared to other hospitals, women who experience PIH are more likely to give birth early before the baby is ready, that is, before 37 weeks, and may cause further health complications to the baby. This normally makes the offspring have low birth weight and exposes them to many complications in infancy and the future in case they are born to mothers with PIH. In severe cases, PIH may lead to the death of the infant either by stillbirth or immediately after birth. The researchers have noted several predisposing factors to PIH, which include histories of elevated blood pressure, diabetes, being overweight or obese, and having a family history of PIH. Educating women about the presence of PIH and its causes can help them consult health facilities early, thus helping leaders in achieving better pregnancy results.

摘要

在妊娠高血压(PIH)的情况下,其发展历程是一个对该病症的认识逐渐深入、相关必要知识逐步形成的过程。18世纪后期血压计(即血压袖带)的发明,为现代系统记录妊娠患者的血压提供了基础。在接下来的数年乃至数十年间,高血压与子痫前期、子痫等并发症之间的关联愈发清晰。1952年,美国孕产妇福利委员会对高血压疾病进行了分类,其中包括妊娠高血压、慢性高血压和子痫前期。如今,人们关注此类因素的识别、寻求改善疾病治疗的方法、疾病的诊断方式以及提升妊娠结局。妊娠可通过以下两种方式引发高血压:子痫前期和妊娠高血压。这两种情况均属于妊娠诱发高血压(PIH)的范畴。在全球范围内,孕期母婴面临的多数问题都源于妊娠高血压。为了帮助母亲和婴儿,我们需要深入了解其成因、应对方法以及如何密切监测婴儿状况。免疫反应、环境和基因等多方面因素相互作用导致妊娠高血压。这些因素致使胎盘功能异常。当促进胎盘生长的细胞无法正常发挥作用、血管僵硬、身体承受过多压力或者有助于血管生成的化学物质失衡时,情况就会恶化。全身血管收缩,血流量减少,血压升高。这可能导致许多器官功能失常,阻碍胎儿健康发育。多项研究表明,妊娠高血压严重限制胎盘的血液供应,进而影响胎儿生长。研究显示,与其他医院相比,患妊娠高血压的女性更有可能在胎儿尚未足月(即37周前)提前分娩,这可能给婴儿带来更多健康问题。这通常会导致新生儿出生体重偏低,并使他们在婴儿期及未来面临诸多并发症,倘若其母亲患有妊娠高血压。在严重情况下,妊娠高血压可能导致婴儿死产或出生后即刻死亡。研究人员已指出妊娠高血压的若干诱发因素,包括高血压病史、糖尿病、超重或肥胖以及有妊娠高血压家族史。向女性宣传妊娠高血压及其成因,有助于她们尽早咨询医疗机构,从而助力实现更好的妊娠结局。

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