重度子痫前期的护理进展

综述护理措施对重度子痫前期孕产妇的影响,护理措施主要包括护理评估、心理护理、基础护理、病情观察、用药护理、健康指导等,住院治疗及采取周密的护理措施对预防子痫的发生,减少母婴并发症,促进母婴康复,降低孕产妇死亡率及围生儿病死率起到至关重要的作用。     

早发型重度子痫前期与脑卒中

早发型重度子痫前期相关的脑卒中的发病机制有血管反应及遗传因素导致细胞内皮功能障碍、自身免疫增强、脑血管自动调节功能破坏及高血压.脑卒中起病及发病后的临床表现与重度子痫前期及子痫的临床表现有重叠.MRI是妊娠期的首选头部影像学检查,CT及MRI基本可以明确颅内病变性质.其治疗应个体化,提倡定期的孕期检查.     

重度子痫前期和子痫患者39例的护理

回顾分析39例子痫前期和子痫患者的临床资料、抢救及护理体会，提出加强农村围产期孕妇宣教保健工作是预防重度妊高征的关键，提高护士的抢救技术及加强基础护理对确保母婴的抢救成功非常重要。     

早发型重度子痫前期胎儿宫内监测及胎儿生长受限的处理

文章介绍了早发型重度子痫前期胎儿宫内监测的指标、方法等内容,并从几方面介绍了早发型重度子痫前期胎儿生长受限的处理,提出期待治疗中要严密监测胎儿的情况,及早发现胎儿生长受限,并给予及时的治疗,可改善围生儿的结局.     

内皮脂酶在重度子痫前期孕妇血清、胎儿脐血中的表达及意义

目的：研究重度子痫前期（PE）孕妇血清、胎儿脐血中内皮脂酶（EL）的表达及其与血脂代谢的关系,探讨EL在PE发病中的作用。方法：选取行剖宫产分娩的重度PE单胎孕妇30例为病例组,行剖宫产分娩的30例正常孕妇为对照组。ELISA法检测孕妇血清及胎儿脐血中的EL浓度;用全自动生化分析仪检测血脂浓度。分析EL浓度与血脂指标的相关性。结果：（1）与正常孕妇比较,重度PE组孕妇的血清三酰甘油（TG）浓度增高,高密度脂蛋白（HDL）浓度降低,动脉硬化指数（AI）增高,差异均显著（P=0.003）。重度PE组胎儿脐血中TG、总胆固醇（CHO）、低密度脂蛋白（LDL）及AI均显著高于对照组（P=0.000）。（2）重度PE组孕妇的血清EL浓度显著高于对照组（692.96ng／mlVS441.21ng／ml,P=0.000）,而两组胎儿脐血中的EL浓度无显著差异。（3）孕妇血清EL浓度与TG浓度呈正相关（r=0.354,P=0.006）,与HDL浓度呈负相关（r=-0.451,P=0.000）。结论：重度PE孕妇及胎儿脐血中均存在血脂异常,重度PE孕妇血清中EL浓度显著增高。提示EL影响血脂代谢,且其可能与PE的发病机制有关。     

转甲状腺蛋白在重度子痫前期及胎儿生长受限孕妇血清中的表达及意义

目的:探讨转甲状腺蛋白(TTR)与s PE及FGR发病的关系及意义。方法:选取2012年9月1日至2015年2月1日在首都医科大学附属北京潞河医院产检并住院分娩的单胎孕妇120例,将患者分为4组:FGR组、s PE组、s PE+FGR组和对照组(各30例)。ELISA法检测TTR浓度。比较4组患者的年龄、孕次、产次、孕周、母血清TTR浓度等指标。结果:4组患者的年龄、孕次、产次、孕周等比较,差异无统计学意义(P0.05)。FGR组、s PE组及s PE+FGR组的母血TTR浓度较对照组明显降低,差异有统计学意义(P0.01)。s PE组血清中TTR含量低于FGR组,差异有统计学意义(P0.01)。结论:TTR在s PE、FGR和s PE+FGR孕妇血清中表达下调,有望成为s PE及FGR发生的生物标志物。s PE合并FGR可能由s PE本身的病理变化引起,s PE与FGR有着共同的病理基础。     

重度子痫前期产前风险评估及临床意义

目的:探讨重度子痫前期产前风险评估的方法及临床意义。方法:回顾性分析我院收治的152例重度子痫前期患者的临床资料,根据改良子痫前期风险评估方法评分,将患者分为A组(评分≤6分)71例、B组(6分<评分<10分)39例和C组(评分≥10分)42例,比较3组间孕妇的住院情况、并发症发生及围生儿结局等方面的差异。结果:3组患者分娩前血压、入院孕周、分娩孕周和治疗时间比较,差异有高度统计学意义(P<0.01);3组患者总并发症发生率、新生儿窒息、胎儿生长受限(FGR)、围生儿死亡率比较,差异均有高度统计学意义(P<0.01),但两两比较,A组与B组差异无统计学意义(P>0.05),C组分别与A组、B组比较,差异有高度统计学意义(P<0.01);有并发症的孕妇其新生儿窒息率、FGR发生率和围生儿死亡率均高于无并发症的孕妇(P<0.05)。结论:重度子痫前期的风险评分越高、病情越重,但其病情呈一定的发展过程,仅病情进展到一定程度才影响母婴预后。重视对患者病情的整体风险评估对临床治疗及选择合适分娩时机有积极意义。     

妊娠中期孕妇血清中可溶性endoglin水平对重度子痫前期预测的探讨

目的探讨妊娠中期14～20周孕妇血清中可溶性endoglin（sEng）水平是否对重度子痫前期有预测价值。方法前瞻性留取2008年11月至2009年10月妊娠14～20周孕妇行唐氏筛查时的血清,追踪孕妇的妊娠结局,获取早发型重度子痫前期组14例,晚发型重度子痫前期组25例,正常对照组25例和早产组13例,用ELISA方法测定各组孕妇妊娠中期血清中sEng的浓度,数据表示为中位数（四分位数间距）形式。结果早发型重度子痫前期组、晚发型重度子痫前期组、正常对照组和早产组孕妇妊娠中期血清中的sEng浓度分别为0.440ng/ml（0.526ng/ml）、0.594ng/ml（0.457ng/ml）、0.483ng/ml（0.194ng/ml）、0.460ng/ml（0.204ng/ml）。各组孕妇血清中sEng浓度间差异无统计学意义（Chi-Square值=1.371,P=0.712）。结论妊娠中期14～20周孕妇血清中的sEng水平对重度子痫前期尚未显示出明显的预测价值。     

早发型重度子痫前期与产后出血

文章介绍了早发型重度子痫前期发生产后出血的临床常见原因为子宫收缩乏力及凝血功能障碍.其治疗除一般复苏及静脉应用缩宫素外,可应用B-Lynch缝合、Hayman子宫压缩缝合等手术疗法及动脉栓塞治疗.并指出低分子肝素可预防产后出血发生.     

重度子痫前期患者分娩前后心脏损伤比较

目的:比较早发型与晚发型重度子痫前期(PE)患者的心脏损伤情况。方法:选取2012年4月至2014年5月在我院产科住院分娩的早发型及晚发型重度PE孕妇各50例,检测静脉血中心肌肌钙蛋白、心肌酶谱、脑钠肽前体含量,同时行心脏彩色多普勒超声检查。判定重度PE患者是否存在心脏损伤,并比较早发型与晚发型重度PE患者的心脏损伤程度的差异。结果:早发型及晚发型的重度PE孕妇的产前各项指标异常率均明显高于同期正常妊娠组,差异有统计学意义(P<0.05),但两种类型重度PE之间比较差异无统计学意义(P>0.05);两种类型产后各项指标均基本正常,差异无统计学意义(P>0.05)。结论:两种类型重度PE明显增加孕妇心脏损害的概率。早发型及晚发型患者产前心脏损害为可逆性。联合运用多种检测手段可早期发现重度PE患者心脏损害。     

Left ventricular remodeling and diastolic function in chronic hypertensive pregnant women

Hypertension during pregnancy is a problem that impacts maternal morbidity and mortality. Dyspnea and edema are common symptoms, often secondary to physiological changes, but may raise doubts as to ventricular dysfunction.ObjectiveTo evaluate the ventricular geometry pattern and diastolic function in chronic hypertensive pregnant women (HPW).MethodsProspective, cross-sectional study on 62 pregnant women over a 29-month period, from March 2009 to July 2011, in Brazil was done. Thirty-one HPWs and 31 normotensive pregnant women (NPW) underwent clinical and cardiovascular evaluations, and were subjected to transthoracic echocardiogram.ResultsLV mass (HPW: 220.9 ± 43.3 vs. NPW: 192.9 ± 39.8 g, p = 0.01), posterior wall thickness (HPW: 9.9 ± 1.1 vs. NPW: 9.2 ± 0.9 mm, p = 0.005), mitral flow A wave velocity (HPW: 0.60 ± 0.16 vs. NPW: 0.52 ± 0.10 m/s, p = 0.02), tissue Doppler A′ wave velocity (HPW: 10 ± 2 vs. NPW: 8.9 ± 1 cm/s, p = 0.02), and E/E′ ratio (HPW: 6.8 ± 2.2 vs. NPW: 5.5 ± 1.6, p = 0.01) were higher in HPWs. Septal and lateral walls E′ wave velocities (HPW: 13 ± 2 vs. NPW: 15 ± 3 cm/s, p = 0.001), and E′/A′ ratio (HPW: 1.26 ± 0.38 vs. NPW: 1.77 ± 0.49, p = 0.00003) were lower in HPWs. There was a positive linear correlation between body mass index (BMI) and ventricular mass, A wave, systolic, diastolic blood pressures, and a negative correlation between BMI, E′ wave and E′/A′ ratio.ConclusionVentricular remodeling showed a direct relationship with body weight, and both groups showed a predominant pattern of eccentric ventricular hypertrophy. The LV diastolic function was abnormal in HPWs.     

Long-term treatment with nicardipine for severe pre-eclampsia.

OBJECTIVE: To evaluate the safety of long-term nicardipine treatment in severely pre-eclamptic women and their fetuses/newborns. METHODS: We divided 50 pregnant women into three groups according to the length of their treatment: short-term treatment of severely pre-eclamptic women (7 days or less, n=20); medium-term treatment also of severely pre-eclamptic women (8-28 days, n=20); and long-term treatment of women with severe superimposed pre-eclampsia (29 days or more, n=10). RESULTS: Nicardipine significantly lowered both systolic (P<0.01) and diastolic blood pressures (P<0.025) in all three groups. The incidence of delivery before 28 weeks of gestation was very low in all three groups. There were no maternal or fetal/neonatal adverse effects. CONCLUSION: Our results suggest that long-term treatment with nicardipine for severe pre-eclampsia is as effective and safe as a short- and medium-term treatment.     

Increased plasma levels of the novel vasoconstrictor peptide endothelin in severe pre-eclampsia

Plasma endothelin levels were studied in 29 pregnancies.

Levels were found to be increased in 9 pregnancies complicated by pregnancy-induced hypertensive disease and/or pre-eclampsia as compared to levels in 14 normotensive pregnancies with gestational age varying between 24–40 weeks with normal Doppler flow velocity waveforms of the uterine arcuate arteries, and 6 normotensive pregnancies with abnormal Doppler flow velocity waveforms at 24 weeks' gestation.

Two patients with severe pre-eclampsia showed a rise in plasma endothelin levels, suggesting a correlation between plasma endothelin levels and the disease process. Endothelin is produced by endothelial cells of blood vessels; it is the most potent vasoconstrictor known to date. For this reason it has been suggested that endothelin might be important in the control of systemic blood pressure and local blood flow, both disturbed in pre-eclampsia. The conclusion of this study is that the venous plasma level of endothelin would seem to be a marker for severe disease, however, without any predictive value.     

Urinary protein excretion and expectant management of early onset, severe pre-eclampsia.

OBJECTIVE: To evaluate the importance of proteinuria in the expectant management of early onset, severe pre-eclampsia. METHODS: In this prospective series of 340 women, 24-h urine collections were performed and monitored twice weekly in a high-care ward. RESULTS: Seventy-four women with at least two 24-h urine collections were grouped into women with a proteinuria increase of > or =2 g (n=29) and with women whose proteinuria decreased, or increased by <2 g (n=45). Major maternal complications, prolongation of gestation, and perinatal outcomes were comparable. Fifty-six (75%) women experienced an increase in proteinuria. When patients with heavy proteinuria (n=83) were compared to those with moderate proteinuria (n=257), maternal and perinatal outcomes were comparable. More days were gained before delivery in the heavy proteinuria group than in the moderate (12 vs. 9; P<0.001). CONCLUSION: Most patients experienced increased proteinuria. Neither the rate of increase nor the amount of proteinuria affected maternal and perinatal outcomes.     

Lipoprotein(a) levels in women with pre-eclampsia and in normotensive pregnant women

AIM: To determine if plasma lipoprotein(a) levels are elevated in pre-eclampsia and if so, their association with the severity of the disease. METHODS: Ninety-one pre-eclamptic (48 mild, 43 severe) and 40 healthy normotensive pregnant women at more than 32 gestational weeks were recruited into study. Plasma levels of lipoprotein(a), lipids, total protein, albumin and fibrinogen were measured in all subjects. RESULTS: All groups were comparable with respect to maternal age, maternal weight, gravidity and parity. Platelet count, total serum protein and albumin levels were significantly decreased, whereas fibrinogen levels significantly increased in the pre-eclamptic group. There was no difference between the groups with respect to total cholesterol and low-density lipoprotein levels. In the pre-eclampsic group, triglyceride and very-low-density lipoprotein concentrations were significantly higher, whereas high-density lipoprotein levels were significantly lower. No difference in serum lipoprotein(a) levels was found between the three groups. CONCLUSIONS: No statistically significant difference existed between normotensive pregnant, and pre-eclamptic women, with regard to plasma lipoprotein(a) levels. It is improbable that high serum lipoprotein(a) levels are risk factors for the development of pre-eclampsia; however, elevated triglyceride-rich lipoproteins might cause endothelial damage leading to pre-eclampsia.     

Plasma endothelin and big endothelin levels in women with severe preeclampsia or HELLP-syndrome

Objective: To compare maternal and umbilical venous big endothelin (big ET) and endothelin-1 (ET-1) levels of pregnancies complicated by severe preeclampsia (PE) or HELLP-syndrome to those of a well-matched normotensive pregnant control group. Methods: We measured plasma levels of ET-1 and big ET in 16 patients with severe PE and 14 patients with HELLP-syndrome by commercially available RIAs and compared them with those of well-matched normotensive pregnant controls. Additionally, the umbilical venous ET-1 and big ET levels were determined in 10 corresponding newborns. Results: The plasma concentrations of ET-1 and big ET were significantly higher in patients with severe PE and especially in women with HELLP-syndrome when compared with controls. The molar ratios of big ET to ET-1 were significantly lower in the two study groups. The levels of ET-1 and big ET were higher in umbilical venous plasma than in maternal plasma, but there were no significant differences in the umbilical venous concentrations between normotensive and by severe PE or HELLP-syndrome complicated pregnancies. Conclusions: These findings suggest that ET-1 may be considered as a marker of endothelial injury in by severe preeclampsia or HELLP-syndrome complicated pregnancies. The increase of the ET-1 plasma levels may be due, at least in part, to changes in the conversion of big ET to ET-1 by the endothelin-converting enzyme. Received: February 1997 / Accepted: July 1997     

Evaluation of inflammatory mediators in the deciduas of pregnant women with pre-eclampsia/eclampsia

Objective: The objective was to evaluate some inflammatory mediators, i.e. cytokines that induce and inhibit nitric oxide (NO) synthase, in pregnant women with pre-eclampsia/eclampsia (PE/E) compared to clinically normal patients.

Methods: Placental fragments were collected from 46 pregnant patients, including 30 clinically normal subjects and 16 women with PE/E, and stored in NP40-containing phosphate buffer in a freezer at ?70?°C until the time of solubilization. Cytokines IL-4, IL-10, IL-13, TNF-α and IFN-γ were assayed by ELISA and NO was estimated by the Griess reaction after reduction.

Results: Patients with PE/E presented significantly lower placental levels of IL-10 and IL-3 than the control group (p?<?0.05). On the other hand, IL-4, TNF-α and IFN-γ levels were similar on the two groups, whereas nitrite/nitrate levels were significantly lower in the PE/E group. A higher inflammatory balance was observed in patients with PE/E compared to normal subjects (p?<?0.05).

Conclusion: Patients with PE/E present lower levels of Th2 cytokines associated with a pro-inflammatory balance as evaluated by the IL-10/TNF-α ratio, as well as lower nitrite/nitrate levels, than controls.     

Ibuprofen versus acetaminophen as a post-partum analgesic for women with severe pre-eclampsia: randomized clinical study

Objective: To compare differences in blood pressure levels between patients with severe post-partum pre-eclampsia using ibuprofen or acetaminophen.

Methods: A randomized controlled trial was made in women with severe pre-eclampsia or superimposed pre-eclampsia after vaginal birth. The patient was randomly selected to receive either 400?mg of ibuprofen every 8?h or 1?g of acetaminophen every 6?h during the post-partum. The primary variable was systolic hypertension ≥150?mmHg and/or diastolic hypertension ≥100?mmHg after the first 24?h post-partum. Secondary variables were the arterial blood pressure readings at 24, 48, 72, and 96?h post-partum and maternal complications.

Results: A total of 113 patients were studied: 56 in the acetaminophen group and 57 in the ibuprofen group. With regard to the primary outcome, more cases were significantly hypertensive in the ibuprofen group (36/57; 63.1%) than in the acetaminophen group (16/56; 28.6%). Severe hypertension (≥160/110?mmHg) was not significantly different between the groups, 14.5% (acetaminophen) and 24.5% (ibuprofen). The levels of arterial blood pressure show a hammock-shaped curve independent of the drug used, however, is more noticeable with ibuprofen.

Conclusions: This study shows that ibuprofen significantly elevates blood pressure in women with severe pre-eclampsia during the post-partum period.     

孕妇外周血中胎儿DNA水平检测在子痫前期诊断中的应用

目的探讨孕妇外周血中胎儿DNA水平检测在子痫前期诊断中的应用价值。方法选择30例子痫前期孕妇为子痫前期组(其中轻度18例,重度12例),另选择30例正常孕妇作为对照组,两组孕妇分别于孕20周、孕晚期(子痫前期组孕33周+3、对照组孕34周+3)、分娩后1、3、6 h取外周血,采用荧光定量PCR检测外周血中Y染色体上的性别决定基因(SRY基因)胎儿DNA水平(B超确定两组孕妇所妊娠的胎儿均为男性);放射免疫法检测两组孕妇孕晚期内皮素水平。结果(1)子痫前期组孕20周时的胎儿DNA水平为(316±61)copy/m l,其中轻度、重度患者分别为(266±79)、(396±91)copy/m l;对照组孕妇为(165±43)copy/m l,子痫前期组及轻度、重度患者明显高于对照组,两组比较,差异有统计学意义(P<0.01)。(2)子痫前期组孕晚期胎儿DNA水平为(970±413)copy/m l,其中轻度、重度患者分别为(758±357)、(1285±573)copy/m l,对照组孕妇为(319±99)copy/m l,子痫前期组及轻度、重度患者明显高于对照组,两组比较,差异有统计学意义(P<0.01)。(3)子痫前期组产后1、3、6 h胎儿DNA水平分别为(139±45)、(76±31)、(44±13)copy/m l,其中轻度患者分别为(102±42)、(57±25)、(36±12)copy/m l,重度患者分别为(209±51)、(97±40)、(52±17)copy/m l;对照组分别为(33±13)、(9±5)、0 copy/m l。子痫前期组及轻度、重度患者明显高于对照组,两组比较,差异有统计学意义(P<0.01)。(4)子痫前期组内皮素水平为(80±18)ng/L,其中轻度患者为(74±14)ng/L,重度患者为(89±32)ng/L;对照组为(50±11)ng/L,子痫前期组及轻度、重度患者明显高于对照组,两组比较,差异有统计学意义(P<0.01)。(5)子痫前期组胎儿DNA水平与内皮素水平呈正相关关系(r=0.748,P<0.01)。结论孕妇外周血胎儿DNA水平变化可以作为预测和诊断子痫前期发病与疾病程度的一个指标。     

Antithrombin improves fetal condition in women with severe pre-eclampsia before 32 weeks of gestation; a randomized, double-blind, placebo-controlled trial

AIM: To see if antithrombin (AT) supplementation improved fetal outcomes in early onset (<32 weeks) severe pre-eclampsia. METHODS: A subgroup re-analysis of an original randomized controlled trial of AT in pre-eclampsia between 24 and 35 weeks of gestation was performed. Either AT (3000 IU/day, n=42) or placebo (Albumin 582 mg/day, n=42) were administered for 7 days. Fetal weight gain, biophysical profile score and fetal heart rate monitoring were evaluated during the treatment week and until delivery. Comparisons were performed by intent-to-treat and relative risk (RR) and 95% Confidence Intervals (CI) were obtained. RESULTS: In each group, 27 women (64%) completed the allocated intervention. AT significantly decreased the worsening of the fetal biophysical profile score or fetal heart rate monitoring (RR 0.24, 95% CI 0.07-0.8), increased the incidence of estimated weight gain >15 g/day during the intervention week (3.1, 1.0-9.9), and prolonged gestational age to >or= 34 weeks (3.6, 1.05-12.6), however infant mortality rates did not differ between the two groups. No adverse events related to AT were observed. CONCLUSIONS: Supplementation of AT preserves fetal biophysical condition and weight gain in early onset severe pre-eclampsia and most likely prolongs pregnancies >or= 34 weeks of gestation.