Opie H, Snyder T E
Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City 66160-7316.
Kans Med. 1993 Apr;94(4):105-9.
Diagnosis of preeclampsia involves consideration of many different factors. It is desirable to make the diagnosis early in the disease course for the best possible outcome for mother and fetus. Overdiagnosis may occur in some cases; however, given the severe maternal and fetal morbidity in cases of untreated disease, it is best to monitor and treat symptoms before they become severe. Overall goals of treatment include prolonging the pregnancy as long as possible without compromise of maternal health, while monitoring the fetus for signs of distress. Treatment for the mother is symptomatic, with seizure prophylaxis and hypertension control. In gestations less than 32 weeks, it is desirable to expose the fetal lungs to at least 48 hours of corticosteroids before delivery to enhance lung maturity. Studies of preeclampsia have demonstrated high fetal morbidity/mortality for gestations less than 24 weeks. With expectant management, decreased fetal morbidity and mortality are shown for both 24- to 27- and 28- to 34-week gestations. Secondary to excellent fetal survival, immediate delivery is indicated for severe disease at gestation greater than 34 weeks.
子痫前期的诊断涉及诸多不同因素。为了母亲和胎儿获得最佳可能的结局，希望在疾病进程早期做出诊断。某些情况下可能会出现过度诊断；然而，鉴于未治疗疾病时母婴的严重发病率，最好在症状变得严重之前进行监测和治疗。治疗的总体目标包括在不损害母亲健康的前提下尽可能延长孕周，同时监测胎儿是否有窘迫迹象。对母亲的治疗是对症治疗，包括预防惊厥和控制高血压。在孕周小于32周时，希望在分娩前让胎儿肺部暴露于至少48小时的皮质类固醇以提高肺成熟度。子痫前期研究表明，孕周小于24周时胎儿发病率/死亡率较高。通过期待治疗，24至27周以及28至34周孕周的胎儿发病率和死亡率均有所降低。由于胎儿存活率高，孕周大于34周的严重疾病患者需立即分娩。
