Blood pressure; extracellular fluid volume; renal plasma flow; glomerular filtration rate; plasma concentrations of renin, angiotensin, aldosterone, desoxycorticosterone, and prostaglandins; responses to infused angiotensin; and many other factors are altered during normal and hypertensive gestation. The diagnosis of the exact disease process responsible for hypertension in pregnancy in an individual patient is extremely difficult if based solely on clinical criteria. The American College of Obstetricians and Gynecologists has suggested the following clinical classifications: (1) preeclampsia-eclampsia, (2) chronic hypertension of whatever cause, (3) chronic hypertension with superimposed preeclampsia, and (4) late or transient hypertension. The three broad categories of renal disease responsible for these clinical syndromes are: (1) preeclampsia-eclampsia, (2) hypertensive changes, and (3) various primary renal diseases. Controversy abounds regarding the aggressiveness of therapy in this syndrome. We prefer a middle-of-the-road approach, bringing blood pressure down to the range of 95 to 100 mm Hg. Hydralazine and Aldomet are the usual drugs of choice. Any intervening nervous system hyperexcitability suggests impending eclampsia and should be immediately treated with magnesium sulfate. The long-term prognosis for the mother with pure preeclampsia appears to be excellent. Most infants born of hypertensive gestations are small for date, with a prognosis that is also affected by the underlying disease of the mother.
血压；细胞外液量；肾血浆流量；肾小球滤过率；肾素、血管紧张素、醛固酮、脱氧皮质酮和前列腺素的血浆浓度；对输注血管紧张素的反应；以及许多其他因素在正常妊娠和妊娠高血压期间都会发生改变。如果仅基于临床标准，要诊断个体患者妊娠高血压的确切疾病过程极其困难。美国妇产科医师学会提出了以下临床分类：（1）子痫前期 - 子痫，（2）任何原因引起的慢性高血压，（3）慢性高血压并发子痫前期，以及（4）晚期或短暂性高血压。导致这些临床综合征的三大类肾脏疾病是：（1）子痫前期 - 子痫，（2）高血压性改变，以及（3）各种原发性肾脏疾病。关于该综合征治疗的积极程度存在诸多争议。我们倾向于采取折中的方法，将血压降至95至100毫米汞柱的范围。肼屈嗪和甲基多巴是常用的首选药物。任何介入的神经系统过度兴奋提示即将发生子痫，应立即用硫酸镁治疗。单纯子痫前期母亲的长期预后似乎很好。大多数高血压妊娠出生的婴儿小于孕周，其预后也受母亲潜在疾病的影响。
