从指南变迁看妊娠期高血压疾病的诊治

妊娠期高血压疾病(hypertensive disorders in pregnancy，HDP) 是妊娠与血压升高并存的一组疾病。加强孕期 的监测和孕期血压的管理是预防子痫前期、改善母婴结局的关键。血压和蛋白尿是孕期监测的重点。指南推荐可 用于孕期的降压药物包括甲基多巴、拉贝洛尔或硝苯地平等。子痫前期的早期筛查和干预是女性孕期心血管风险 防范的关键之一。除药物干预之外，体重控制、生活方式干预、筛查和治疗阻塞性睡眠呼吸暂停等也不容忽视。     

探讨妊娠期高血压疾病子痫前期的产前观察与护理效果

目的探讨妊娠期高血压疾病子痫前期产妇的产前观察与护理方法,观察产妇的护理效果及其分娩结局。方法选取2018年2月至2019年3月期间收治的68例妊娠期高血压疾病子痫前期产妇作为研究对象,分为观察组(产前观察+护理干预)和对照组(常规护理)各34例,观察两组产妇的护理效果。结果与对照组相比,观察组产妇的护理满意度(97.06%>76.47%)相对更高(P<0.05),而收缩压(SBP)水平[(133.91±10.72)mmHg<(149.67±12.54)mmHg]、[(90.88±8.02)mmHg<(101.36±10.18)mmHg]以及不良妊娠结局发生率(11.76%<33.33%)相对更低(P<0.05)。结论产前观察与护理干预的有效开展,能够有效控制妊娠期高血压疾病和子痫前期症状,为产妇的安全、顺利分娩提供保障,改善分娩结局。     

妊娠期高血压疾病的规范化诊断与治疗

妊娠期高血压疾病是临床上一类常见疾病。该病以妊娠妇女出现血压异常增高为主要表现,可伴有不同程度的靶器官损害,可对孕产妇和胎儿产生严重不利影响。妊娠期高血压疾病包括孕前高血压患者以及妊娠期出现的高血压、子痫前期以及子痫等。南于病理生理机制与临床特点不同,其防治原则与非妊娠期慢性高血压亦显著不同。在妊娠期高血压综合征的综合管理过程中,既要适度控制血压,预防或延缓南血压升高所致的靶器官损害,还需充分顾及孕、产妇与胎儿的安全,     

早期干预治疗妊娠期高血压疾病高危因素对妊娠结局的影响

目的 探讨早期干预治疗妊娠期高血压疾病高危因素对妊娠结局的影响.方法 对2006年1月-2007年6月在我院产科门诊就诊的1 050名孕妇中筛查出具有妊娠期高血压疾病高危因素的孕妇200例,高度重视.重点管理,及早进行干预治疗.结果 200例具有妊娠期高血压疾病高危因素的孕妇中有13例发生妊娠期高血压疾病,发病率为6.5%,明显低于我国9.4%的平均发病率,且无重度子痫前期及子痫发生,未发生脑血管意外等并发症,母婴健康状况良好.结论 对孕妇及早进行妊娠期高血压疾病的高危因素筛壹,高度重视,重点管理,及早进行干预治疗,可预防和减轻妊娠期高血压疾病的发生,保障母婴健康,提高人口素质.     

母体血浆细胞纤维结合蛋白不同时期预测妊娠期高血压疾病的价值

目的：研究妊娠期高血压疾病患者母体血浆纤维结合蛋白（fibronectin,Fn）在妊娠期间的序列变化以及对疾病的预测价值。方法：采用前瞻性研究方法,对180例妊娠前正常的孕妇,应用酶联免疫吸附试验（ELISA）的方法,检测母体血Fn在妊娠10～14、20～24、30～34周的水平,观察孕妇孕期的变化并随访妊娠结局;同时选取50例正常未孕妇女作为未孕对照。结果：①180例中有12例发生妊娠期高血压（妊娠期高血压组）,10例子痫前期,4例重度、6例轻度（子痫前期组）,158例孕妇妊娠结局正常（正常妊娠组）。②正常妊娠孕妇,母体血浆Fn在妊娠10～14、20～24周维持正常未孕水平,而在妊娠30～34周明显升高,均差异有统计学意义（均P〈0．01）;在妊娠10～14周,子痫前期组、妊娠期高血压组与正常妊娠母体血浆Fn浓度比较差异无统计学意义;在妊娠20～24、30～34周,子痫前期与其他2组比较均差异有统计学意义（均P〈0．01）,而妊娠期高血压与正常妊娠组比较,均差异无统计学意义（均P〉0．05）。③通过ROC曲线分析,母体血浆Fn在妊娠20～24、30～34周预测子痫前期曲线下面积分别为0．858、0．846（均P〈0．01）,妊娠20～24周最佳切入值为388．65mg／L,其敏感性、特异性、阳性预测值、阴性预测值、阳性似然比分别为100．00％、78．24％、21．28％、100．00％、4．85;妊娠30～34周最佳切入值为416．95mg／L,值分别为100．00％、77．06％、20．00％、100．00％、4．25。结论：子痫前期中晚期母体血浆Fn明显升高,而妊娠期高血压保持同期正常妊娠水平;妊娠中晚期母体血浆Fn对预测子痫前期有较好的特异性,妊娠20～24周的预测价值优于妊娠30～34周。     

妊娠期高血压疾病血压管理中国专家共识

妊娠期高血压疾病是孕产妇和胎儿死亡的重要原因。由于国内外大型随机对照试验均不会纳入妊娠与哺乳期妇女,因此,至今尚缺乏妊娠期高血压疾病降压药物治疗的新证据。为了规范妊娠期高血压疾病患者的血压管理,中国医师协会高血压专业委员会在征求妇产科专家意见的基础上,组织制定了此共识文件,充分分析了现有的研究和治疗现状。     

孕妇血清细胞因子及同型半胱氨酸水平与妊娠期高血压疾病的相关性研究

目的 探究孕妇血清细胞因子及同型半胱氨酸（homocysteine,Hcy）表达水平与妊娠期高血压疾病的相关性。方法 回顾性分析保定市妇幼保健院2020年～2021年3月收治的113例妊娠期高血压疾病患者的临床资料,另选取同期来我院进行健康体检的70例正常妊娠孕妇作为正常妊娠组;比较两组Hcy、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素4(Interleukin-4,IL-4)、胱抑素C(Cystatin C,CysC)、超敏C反应蛋白（hypersensitive C-reactive protein,hs-CRP）、D-二聚体（D-Dimer,D-D）水平,采用Spearman相关性分析Hcy、TNF-α、IL-4、CysC、hs-CRP、D-D水平与妊娠期高血压疾病的关系。结果 (1)妊娠期高血压疾病组TNF-α水平显著高于正常妊娠组,妊娠期高血压疾病组IL-4水平显著低于正常妊娠组,P<0.01;(2)妊娠期高血压疾病组Hcy、CysC、hs-CRP、D-D水平均显著高于正常妊娠组,P<0.01;(3)Spearman...     

妊娠期高血压疾病相关因素及对妊娠结局的影响

目的探讨妊娠期高血压疾病(HDCP)相关因素及对妊娠结局的影响。方法将2009-01~2015-12该院收治的HDCP患者82例作为研究组,同期选择健康孕(产)妇82名作为对照组,分析HDCP的相关危险因素,并对比分析两组妊娠结局。结果研究组年龄≥35岁、孕前体重指数(BMI)≥25 kg/m2、经产妇、高中以下、有高血压家族史所占比例均明显高于对照组,而家庭月收入、血清钙浓度则明显低于对照组(P0.05)。多因素Logistic回归分析显示年龄(OR=2.116,95%CI=1.207~3.618)、高血压家族史(OR=1.604,95%CI=1.305~2.573)、孕前BMI(OR=1.805,95%CI=1.298~2.324)、文化程度(OR=1.230,95%CI=0.716~1.815)为HDCP的相关危险因素。研究组剖宫产率以及低出生体重儿、新生儿窒息、早产、产后出血发生率均明显高于对照组(P0.05)。结论年龄、高血压家族史、孕前BMI、文化程度为HDCP的相关危险因素,而HDCP会对妊娠结局产生多种不利影响。     

高压氧联合低分子肝素对妊娠期高血压疾病患者血管内皮功能和母婴结局的影响

目的 探究高压氧联合低分子肝素对妊娠期高血压疾病患者血管内皮功能和母婴结局的影响。方法 选择102例妊娠期高血压疾病患者,随机将其分为对照组和观察组,每组51例。在常规降压、解痉、镇静等治疗的基础上,对照组行注射低分子肝素治疗,观察组在对照组基础上行高压氧治疗。10 d为1个疗程,两组均治疗3个疗程。比较两组临床疗效和母婴不良结局发生情况,以及治疗前后血压(舒张压、收缩压)、凝血功能指标[纤维蛋白原、D-二聚体、活化部分凝血活酶时间(APTT)、凝血酶原时间]、血管内皮功能(内皮素-1、一氧化氮、胎盘生长因子、可溶性内皮因子)。结果 治疗3个疗程后,观察组治疗总有效率(92.16%)高于对照组(76.47%),舒张压、收缩压、血清纤维蛋白原水平、血清D-二聚体水平、血清内皮素-1水平、血清可溶性内皮因子水平均低于对照组,血清APTT、血清凝血酶原时间、血清一氧化氮水平、血清胎盘生长因子水平均长于/高于对照组(均P<0.05)。观察组母婴不良结局的总发生率(9.80%)低于对照组(24.49%)(P<0.05)。结论 高压氧联合低分子肝素能提高妊娠期高血压疾病患者治疗效果,改...     

妊娠期高血压疾病药物治疗的临床护理

妊娠期高血压疾病可严重影响母婴健康。2006年6月-2009年1月,我们采用解痉、镇静、降压、扩容利尿、促胎肺成熟药物治疗妊娠期高血压疾病130例,效果满意。现将护理体会报告如下。     

Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy

Previous reports suggest that renal involvement before pregnancy or active renal disease during pregnancy may be associated with poor fetal and maternal outcomes in systemic lupus erythematosus (SLE) women. We report our experience of fetal and maternal complications in pregnant lupus women with and without previous lupus nephritis. We analyzed the clinical records of pregnant SLE patients attended in a tertiary reference center during a 5-year period. Patients were allocated into two groups according to the presence or absence of previous lupus nephritis. Women were evaluated monthly during pregnancy and at least 1 month postpartum. Maternal and fetal outcomes of pregnancy were abstracted. We included 95 pregnancies in 92 patients. Compared with pregnant women without lupus nephritis (n = 60), pregnancies with previous lupus nephritis (n = 35) were associated with a higher risk of maternal complications (88.5% vs. 43.3%, p = 0.00001), higher rate of lupus flares (54.2% vs. 25%, p = 0.004), and renal flares (45.7% vs. 6.6%, p = 0.00001), but most of which in most instances were reversible. On the other hand, fetal outcome was similar in both groups. Multivariate analysis showed that previous lupus nephritis and active lupus at conception were predictors of adverse maternal outcome. Pregnancies in women with previous lupus nephritis had a higher rate of maternal complications in comparison with those without. However, fetal prognosis was similar in both groups.     

妊娠合并感染性心内膜炎母婴结局分析

目的:探讨妊娠合并感染性心内膜炎(IE)患者的妊娠结局。方法:2009年10月至2014年10月,我院收治6例妊娠合并IE的患者,回顾分析其临床资料,包括孕周、心内膜炎感染类型、心功能分级、终止妊娠方式、手术指征及母婴结局。结果:6例患者均患有心脏疾病,其中先天性心脏病3例(室间隔缺损1例,法洛四联症1例,动脉导管未闭1例),瓣膜病变(中-重度反流+关闭不全)3例。心脏手术5例。分娩方式:6例患者均行剖宫手术终止妊娠,其中2例剖宫产同时性心脏手术。母亲结局:6例患者均痊愈出院。胎儿结局:剖宫取胎术1例,早产4例,足月产1例。5例新生儿无畸形,存活4例,死亡1例。结论:孕期合并IE发病凶险,严重威胁母儿安全,致死率高,临床上须引起重视,积极治疗。妊娠期心脏手术是可行的,剖宫产是终止妊娠适宜的分娩方式。     

Morbidity and maternal and infant outcomes of hypertensive disorder in pregnancy in China in 2018

Hypertensive disorder in pregnancy is a disease that occurs during pregnancy. We aimed to analyze the morbidity and maternal and infant outcomes with respect to the hypertensive disorder in pregnancy in China in 2018. Clinical data of 38 590 cases from 161 hospitals were retrospectively collected. The differences in morbidity and maternal and infant mortality among the major regions and provinces were compared. The overall national average morbidity was 4.74%, and the ratios of gestational hypertension, preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia were 29.17%, 55.02%, 0.66%, 6.53%, and 8.62%, respectively. The overall maternal mortality was 0.61/100 000, and the case fatality was 0.13%. Morbidity associated with hypertensive disorder in pregnancy was 7.74% in North China, 6.62% in Northwest China, 6.40% in Central China, 5.83% in Northeast China, 4.28% in East China, 3.85% in South China, and 2.88% in Southwest China. The morbidity in each province was 1.62‐11.28%. The overall perinatal mortality was 3.59% (81.09% for stillbirths; 18.91% for neonatal deaths). Perinatal mortality decreased with increasing gestational weeks from 24 to 37 + 6 weeks. Perinatal mortality for delivery at 32 weeks of gestation in all regions of the country was <10%. Morbidity varied across regions in China, with the lowest in Southwest and the highest in North China. The low maternal mortality is related to the large‐scale development of standardized maternal health care in China. For severe hypertensive disorder patients, gestation should be prolonged to 32 weeks as often as possible for better neonatal survival rates.     

睡眠呼吸障碍对妊娠妇女母婴结局影响的研究进展

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是最常见的睡眠呼吸障碍疾病,该病主要通过间歇性低氧和睡眠片段化对人体呼吸、循环、代谢等多系统产生损害。妊娠期特有的激素水平和生理状态可能诱发或恶化OSAHS,从而增加孕妇的OSAHS患病率。目前,妊娠期OSAHS对孕妇及胎、婴儿妊娠结局的影响已经成为国内外研究热点,但并没有得...     

Epistasis among eNOS, MMP-9 and VEGF maternal genotypes in hypertensive disorders of pregnancy

Polymorphisms of the endothelial nitric oxide synthase (eNOS), matrix metalloproteinase-9 (MMP-9) and vascular endothelial growth factor (VEGF) genes were shown to be associated with hypertensive disorders of pregnancy. However, epistasis is suggested to be an important component of the genetic susceptibility to preeclampsia (PE). The aim of this study was to characterize the interactions among these genes in PE and gestational hypertension (GH). Seven clinically relevant polymorphisms of eNOS (T-786C, rs2070744, a variable number of tandem repeats in intron 4 and Glu298Asp, rs1799983), MMP-9 (C-1562T, rs3918242 and -90(CA)(13-25), rs2234681) and VEGF (C-2578A, rs699947 and G-634C, rs2010963) were genotyped by TaqMan allelic discrimination assays or PCR and fragment separation by electrophoresis in 122 patients with PE, 107 patients with GH and a control group of 102 normotensive pregnant (NP) women. A robust multifactor dimensionality reduction analysis was used to characterize gene-gene interactions. Although no significant genotype combinations were observed for the comparison between the GH and NP groups (P>0.05), the combination of MMP-9-1562CC with VEGF-634GG was more frequent in NP women than in women with PE (P<0.05). Moreover, the combination of MMP-9-1562CC with VEGF-634CC or MMP-9-1562CT with VEGF-634CC or-634GG was more frequent in women with PE than in NP women (P<0.05). These results are obscured when single polymorphisms in these genes are considered and suggest that specific genotype combinations of MMP-9 and VEGF contribute to PE susceptibility.     

Effects of placental proteases on maternal and fetal blood pressure in normal pregnancy and preeclampsia

Although many proteases exist in human placenta, their physiologic roles are still unknown. Our study showed that placental proteases metabolize vasoactive peptides possibly derived from the fetus.Because vasopressin and angiotensin are known to play an important role in normal and aberrant (preeclampsia) fetal-placental circulation, the clearance of these peptides in the placenta is important in controlling fetal blood pressure. Vasopressin and angiotensin act as a fetal-placental vasoconstrictor; therefore, placental proteases in human placenta are likely to work as a clearance factor for these peptides.Although human and animal pregnancy is normally associated with a refractory response to the pressor effect of exogenously infused angiotensin II, patients with preeclampsia, as well as nonpregnant women, are sensitive to the pressor effect of angiotensin II. Our study suggested that the decreased pressor responsiveness to angiotensin II in pregnancy is caused by increased inactivation of angiotensin II by angiotensinase in pregnant serum and the placenta.Although vasopressinase and angiotensinase activities increase with advancing gestation in normal pregnant sera, the activities of both enzymes in severe preeclampsia sera were clearly lower than those in normal pregnancy. Therefore, it is reasonable to speculate that the increased sensitivity to angiotensin II of preeclampsia is attributable to the decreased degradation of angiotensin II by placental angiotensinase.The negative correlations between the systolic to diastolic ratio obtained from pulsed Doppler measurement techniques and the activities of both enzymes in preeclampsia sera suggested that the systolic to diastolic ratio, which reflected constriction of placental vessels, is influenced by the concentration of vasoactive peptides in the fetal-placental circulation due to changes in the activities of placental proteases.Placental proteases play important roles in controlling fetal and maternal blood pressure through regulation of the concentration of vasoactive peptides in the interface (placenta) between fetus and mother.     

Thrombosis in pregnancy: maternal and fetal issues

Pulmonary thromboembolism is the main cause of maternal death in the UK and current trends show an increase. Deep-vein thrombosis underlies this disorder. Important issues include pathophysiology, diagnosis, and management of thrombosis in pregnancy, especially the use of anticoagulants. Congenital and acquired thrombophilias contribute to the pathophysiological processes that underlie miscarriage, intrauterine growth restriction, and pre-eclampsia, and raises new possibilities for intervention. The high prevalence of thrombophilic defects in the population, the association of defects with maternal and fetal disorders, and special considerations for management make it essential for obstetricians to understand this area.     

Neurovascular dysfunctions in hypertensive disorders of pregnancy

Metabolic Brain Disease - Hypertensive disorders in pregnancy pose a huge challenge to the socioeconomic stability of a community; being a major cause of maternal and neonatal morbidity and...