Wang Chunfei, Wei Qiang
Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.
Medicine (Baltimore). 2025 Jun 6;104(23):e42649. doi: 10.1097/MD.0000000000042649.
The prevalence of chronic hypertension among pregnant women is steadily increasing worldwide. Besides chronic hypertension is a major risk factor for preeclampsia (PE). Therefore, the standardization of monitoring and management - focusing on early identification and the judicious use of antihypertensive medications to improve maternal and fetal outcomes - has become a critical concern for clinicians.
A 31-year-old pregnant woman with chronic hypertension exhibited repeated blood pressure of 160/110 mm Hg or higher throughout her pregnancy, and there were no laboratory or clinical signs indicative of PE. Fluctuations in her blood pressure resulted in an acute cerebrovascular accident during the period of expectant management.
Chronic hypertension with severe PE.
The patient was admitted due to acute severe hypertension and received corticosteroids for fetal lung maturation. Expectant management was initially considered due to relatively stable condition during the first 3 days of hospitalization. However, on the 4th day, despite treatment with both oral and intravenous antihypertensive agents, blood pressure remained uncontrolled, even reaching 200/105 mm Hg or higher. Unfortunately, the persistent severe hypertension resulted in an acute stroke, necessitating emergency cesarean section and neurosurgical intervention at 31 + 5 weeks of gestation.
The neonate was transferred to the Neonatal Intensive Care Unit and remained there for 38 days before discharge. The patient was discharged by postoperative day 19 and continued with rehabilitation treatment. At the latest follow-up, muscle strength in her left limb remained at grade 1, with no significant recovery observed.
Pregnant women with chronic hypertension who present persistently elevated and uncontrollable blood pressure should be diagnosed with severe PE. Treatment regimens for hypertensive disorders of pregnancy typically involve oral antihypertensive medications, which should be administered judiciously based on clinical guidelines and trial evidence. For chronic maintenance treatment, labetalol and extended-release nifedipine are recommended as 1st-line agents by most international guidelines, with nifedipine being a viable initial option for severe hypertension. For women with severe PE, after corticosteroids have been administered for fetal lung maturation, an overall assessment of maternal and placental-fetal conditions should guide whether expectant management is feasible or if prompt delivery is required to minimize severe complications.
全球范围内，孕妇慢性高血压的患病率正在稳步上升。此外，慢性高血压是子痫前期（PE）的主要危险因素。因此，以早期识别和合理使用降压药物来改善母婴结局为重点的监测和管理标准化，已成为临床医生至关重要的关注点。
一名31岁的慢性高血压孕妇在整个孕期血压反复高达160/110 mmHg或更高，且没有实验室或临床迹象表明患有PE。在期待治疗期间，她的血压波动导致了急性脑血管意外。
慢性高血压伴重度PE。
患者因急性重度高血压入院，并接受了糖皮质激素以促进胎儿肺成熟。住院的前3天，由于病情相对稳定，最初考虑进行期待治疗。然而，在第4天，尽管使用了口服和静脉降压药物治疗，血压仍未得到控制，甚至达到200/105 mmHg或更高。不幸的是，持续性重度高血压导致了急性中风，在妊娠31 + 5周时需要紧急剖宫产和神经外科干预。
新生儿被转入新生儿重症监护病房，在出院前在那里住了38天。患者在术后第19天出院，并继续进行康复治疗。在最近的随访中，她左下肢的肌力仍为1级，未见明显恢复。
慢性高血压孕妇若出现持续升高且无法控制的血压，应诊断为重度PE。妊娠高血压疾病的治疗方案通常包括口服降压药物，应根据临床指南和试验证据谨慎给药。对于慢性维持治疗，大多数国际指南推荐拉贝洛尔和缓释硝苯地平作为一线药物，硝苯地平是重度高血压的可行初始选择。对于重度PE的女性，在给予糖皮质激素促进胎儿肺成熟后，应全面评估母体和胎盘 - 胎儿状况，以指导期待治疗是否可行，或者是否需要及时分娩以尽量减少严重并发症。
