不典型子痫前期-子痫

子痫前期-子痫是一种妊娠期严重危及母胎安全的并发症,典型症状包括妊娠相关高血压和蛋白尿。近年来,循证医学的研究结果不断呈现对子痫前期-子痫诊治的新认识,国内外学者提出子痫前期-子痫就像许多其他症候群一样在医学上有许多不典型的临床表现。对于临床工作来说,及时准确的诊断和治疗对于改善母胎不良结局有极其重要的作用。总结多项研究及相关文献报道,对不典型子痫前期及子痫的临床表现、诊断及处理进行综述,以对在临床工作中潜在的非典型病例引起重视,及早处理,改善预后。     

酚妥拉明与硫酸镁治疗先兆子痫临床对照研究

目的探讨酚妥拉明与硫酸镁在治疗先兆子痫中的作用.方法88例先兆子痫住院患者,随机分酚妥拉明组和硫酸镁组各44例,酚妥拉明组以5%葡萄糖液500 ml加酚妥拉明30 mg静脉滴注至分娩结束,根据血压调整滴数,24 h酚妥拉明总量为200 mg;硫酸镁组按常规方法用药,24 h硫酸镁总量达24 g.结果用药30min后酚妥拉明组舒张压均值下降2.5±0.2 kPa,而硫酸镁组几无下降,差异十分显著(P＜0.01).酚妥拉明组平均疗程明显短于硫酸镁组(P＜0.01);剖宫产率明显低于硫酸镁组(P＜0.05);自然分娩率高于硫酸镁组(P＜0.01);新生儿窒息率明显低于硫酸镁组(P＜0.05),但两组胎儿宫内窘迫发生率无统计学意义(P＞0.05).结论酚妥拉明治疗先兆子痫能使血压迅速下降,平均疗程明显缩短,不良反应轻.     

硫酸镁治疗及预防子痫研究进展

由于子痫抽的机理现尚不明，对硫酸镁治疗痫的机理长期存在分岐。最近国际多中心治疗试验试验肯定了硫酸镁的治疗效果。而硫酸镁预防子阐述抽的作用仍有较多争议。     

硫酸镁对子痫前期患者母、子血流的影响

硫酸镁对子痫前期患者母、子血流的影响张向丽，江森，刘韶萍，傅庆诏（山东医科大学附属医院，２５００１２）妊娠高血压综合征（妊高征）的主要病理变化是小动脉痉挛、缺血和血管内皮损害。严重子痫前期患者常有脑细胞损害、脑水肿等，这类患者的视力变化又常与脑组织的...     

子痫前期-子痫与妊娠肝内胆汁淤积症

子痫前期-子痫使妊娠期肝内胆汁淤积症的发病风险及围产儿死亡率显著增高。8%肝功能异常的子痫前期-子痫患者出现血胆汁酸升高,可能是机体的一种调节,主要作用可能是保护机体免于胆汁淤积性损伤,而不是形成胆汁淤积的直接原因。     

降低子痫前期患者严重并发症的策略

妊娠期高血压疾病是妊娠最常见的并发症之一,尤其是临床表现严重的子痫前期、子痫和HELLP综合征,可使母亲与胎儿的发病率和死亡率增加,如何及时、准确地诊断和处理关系到患者病情的进展和预后。本文从风险预测、诊断标准和处理原则几个方面阐述了降低子痫前期患者严重并发症发生的策略,以期最大程度改善妊娠期高血压疾病患者的母儿预后。     

子痫前期-子痫相关问题的讨论

主要讨论内容1.子痫前期-子痫的命名与分类2.子痫前期-子痫病因3.子痫前期-子痫的临床处理4.子痫前期-子痫并发HELLP综合征5.子痫前期-子痫合并急性心力衰竭6.子痫前期-子痫并发脑血管意7.子痫前期-子痫并发急性肾功能衰竭8.子痫前期-子痫并发肺水肿9.胎盘早剥的早期诊断问题10     

重新评价静脉注射硫酸镁治疗子痫前期-子痫

在美国硫酸镁是治疗子痫前期-子痫最常用的药物,而已被公认是预防和控制子痫前期发展为子痫的有效方法。自1925年开始即有作者介绍,相继对使用方法和剂量,药物的体内分布及排泄作了大量研究,对硫酸镁的使用剂量和达到治疗水平的血清浓度有不同意见。但一致同意硫酸镁的剂量应根据膝反射,每小时尿排出量及呼吸的速率进行调整。同时认为接受硫酸镁治疗的病人不应当再出现子痫。本文作者自1978年7月1日至1980年3月31日应用硫酸镁静脉点滴治疗1,158例子痫前期,首次用药量为10%硫酸镁4g稀释在5%葡萄糖250ml中静脉点滴,15分钟滴完,随后用维持量1g/dl-hr,其中13例失败,子痫发作是出现在用维持量的2～48小     

子痫前期-子痫的病理生理学研究

子痫前期-子痫（preeclampsia-eclampsia,PE-E）是妊娠期特发性高血压疾病,可伴有脑、心、肝、肾等多脏器损害,是导致孕产妇及围产儿病率和死亡率升高的主要原因.对于此病的研究进程,始终以人们对其临床症状的认识为基础.早在18世纪,人们就认识到PE-E是一种急症,患者可出现蛋白尿.随着对此病临床症状的不断认识,对其病因和发病机理的研究也在不断深入,但到目前为止,PE-E的发病机理仍未完全清楚,是全球产科界的难解之题.     

如何预防子痫前期的严重不良结局

子痫前期是产科常见的并发症,病情进展可造成全身多器官功能损害,如脑血管意外、肺水肿、肾功能衰竭和HELLP综合征等。因此,早期识别、诊断和处理对于预防严重不良结局和改善母儿预后非常重要。     

Postpartum Hyperkalemia Associated with Magnesium Sulfate

We report the case of a woman who first received MgSO₄ for eclampsia prophylaxis and then was treated with MgSO₄ for eclampsia. She developed hyperkalemia without severe renal failure or another explanation. We recommend close monitoring, including serial measurements of electrolytes, when MgSO₄ is administered for eclampsia prophylaxis or treatment.     

Disease burden due to pre-eclampsia/eclampsia and the Ethiopian health system's response

Objective

To assess the maternal disease burden due to pre-eclampsia/eclampsia in Ethiopia and the national health system's readiness to respond to the needs of women with pre-eclampsia/eclampsia.

Methods

The national emergency obstetric and newborn care (EmONC) assessment entailed collecting information from 112 hospitals and 685 health centers in Ethiopia, focusing on their infrastructure, the services they provided, human resources, equipment and supplies, case load, and mortality due to pre-eclampsia/eclampsia.

Results

Pre-eclampsia/eclampsia complicated 1.2% of all institutional deliveries. Given the low institutional delivery rate and an expected incidence of 2%-8% of all deliveries, this implies that only a small fraction (3.8%) of all women with pre-eclampsia/eclampsia received care at health facilities. 11% of all maternal deaths and 16% of direct maternal deaths were due to this obstetric complication. The cause-specific case fatality rate was high (3.6%). Availability of urine test strips, anticonvulsants, antihypertensives, and actual service provision to treat these diseases was limited, especially at health centers.

Conclusion

The salutary effects of the national EmONC assessment were immediate, as evidenced by how quickly the release of the Ethiopian report led to important national efforts to improve maternal and newborn health. Expansion of health services should be augmented with periodic assessments of logistics and quality-related issues to assure functioning facilities for women accessing obstetric services.     

Facility and personnel factors influencing magnesium sulfate use for eclampsia and pre-eclampsia in 3 Indian hospitals

Objective

To identify factors at the health facility and health professional levels that might hinder or facilitate the appropriate use of magnesium sulfate for the treatment of pre-eclampsia and eclampsia.

Methods

Seven focus group discussions were conducted with a purposively sampled group of obstetricians/gynecologists, medical residents, and nurses at 3 hospitals in Nagpur, India. Data were collected on facility and drug availability, criteria for diagnosis and management of pre-eclampsia and eclampsia, attitudes about magnesium sulfate use, and perceived barriers to the treatment of pre-eclampsia and eclampsia.

Results

Senior gynecologists seemed to encourage the use of magnesium sulfate, especially management prior to transfer to a higher facility. However, clinicians noted a lack of specific institutional guidelines on dose, timing, and indications, particularly in cases in which delivery was not imminent. In all facilities, service providers noted that their clinical care decisions were sometimes influenced by political and social factors, making management of eclampsia and pre-eclampsia cases difficult. Care was further challenged by limited drug availability, particularly at the tertiary-care center.

Conclusion

Limited drug supply and lack of specific institutional guidelines, equipment, and trained staff hinder the translation of evidence-based policy on magnesium sulfate into practice.     

Magnesium sulfate compared with lytic cocktail for women with eclampsia.

OBJECTIVE: To compare magnesium sulfate with lytic cocktail for the treatment of eclampsia. METHODS: The register of trials kept by the Cochrane Pregnancy and Childbirth Group and the Cochrane Controlled Trials Register were searched for randomized trials comparing magnesium sulfate with lytic cocktail for the treatment of eclampsia. RESULTS: Two studies were included (a total of 199 women). Magnesium sulfate was more effective than lytic cocktail at preventing further convulsions [relative risk (RR) 0.09, 95% confidence interval (C.I.)=0.03-0.24; risk difference=0.43, 95% C.I.=-0.53 to -0.34; number needed to treat=3, 95% C.I.=2-3) and was associated with less respiratory depression (RR=0.12, 95% C.I.=0.02-0.91) and fewer baby deaths (RR=0.26, 95% C.I.=0.26-0.79). There were non-significantly fewer maternal deaths associated with magnesium sulfate (RR=0.25, 95% C.I.=0.04-1.43). CONCLUSIONS: Magnesium sulfate is the anticonvulsant of choice for eclampsia. Lytic cocktail should be abandoned.     

Magnesium Sulfate Decreases Cerebral Perfusion Pressure in Preeclampsia

Objective: To determine the cerebral hemodynamic effect of magnesium sulfate (MgSO4) in preeclampsia. Design: Prospective observational study. Setting: Tertiary Care Medical Center. Population: Preeclamptic patients (systolic < 160, diastolic < 110 mmHg). Methods: Transcranial Doppler (TCD) of the middle cerebral arteries (MCA) of 15 preeclamptics, before and after IV MgSO4. No vasoactive drugs other than MgSO4 were given. 11 patients with mild range BP (140/90 – 160/110 mmHg) had measurements at baseline, 30 and 120 minutes after MgSO4, and 7 patients with elevated CPP had baseline and 30 minute measurements. Hemodynamic parameters were compared with normative curves. Main Outcome Measures: Mean arterial pressure (MAP), heart rate (HR), cerebral perfusion pressure (CPP), resistance index (RI), resistance area product (RAP), and cerebral flow index (CFI). Results: Eight women had normal baseline CPP, and 11 had normal CFI. 11 had mild preeclampsia range blood pressure and MgSO4 had no significant effect on CPP, CFI, HR, MCA velocities, or RAP but did decrease the MAP in the first 30 minutes (107 +/– 8 to 100+/–9 mmHg; p = 0.035), mainly due to a drop in diastolic pressure (87+/–10 to 82+/– 9 mmHg; p = 0.004). 7 patients with elevated baseline CPP had a significant reduction in CPP, but no change in CFI, after MgSO4. Conclusions: MgSO4 does not significantly effect CPP or CFI in preeclamptics with baseline blood pressure in the mild range, but does significantly reduce CPP in those with high baseline CPP. This may be important in the prevention of hypertensive encephalopathy.     

Zuspan's Scheme Versus an Alternative Magnesium Sulfate Scheme: Randomized Clinical Trial of Magnesium Serum Concentrations

Objective. The purpose of this study was to determine whether magnesium serum concentrations in patients with severe preeclampsia or eclampsia treated with two different magnesium sulfate schemes were different. Methods. Fourteen patients were randomly assigned in the alternative scheme group and 15 in the Zuspan's group. The difference between the groups was that the intravenously administered maintenance dose was done with 1 g/h by continuous intravenous infusion in the Zuspan's group and 2g in bolus every two hours in the alternative scheme. Blood samples were collected previously to treatment and every 15 minutes during four hours after the beginning of treatment. The primary outcome measure was area under the curve and the t-test was used for statistical analysis with level of statistical significance of 5%. The evaluation of the punctual means at all moments in the alternative group was done with the repeated measures analysis of variance. Results. There was no significant difference in the baseline characteristics between groups. In both schemes, magnesium serum concentration reaches a peak within 15 minutes and a new peak was observed after maintenance dose in the alternative scheme. The area under the curve was significantly lower in the alternative scheme than in the Zuspan's scheme (702.1 ± 73.5 mg/dL vs 796.1 ± 94.6 mg/dL). Conclusion. The serum magnesium concentration of this randomized clinical trial doesn't support the use of the alternative scheme of magnesium sulfate to prevent or treat eclampsia.     

子痫前期相关miRNAs的研究进展

子痫前期是妊娠特异性疾病,是孕妇和新生儿死亡的主要原因之一,但是目前发病机制尚不清楚。微小RNA(micro RNA,mi RNA)是一类具有组织特异性、发育阶段特异性和疾病特异性表达的非编码小RNA,含有21~25个核苷酸,参与基因转录后水平的调控。mi RNA在维持胎盘的正常发育中发挥着重要作用,其异常表达常导致胎盘发育不良,进而导致妊娠相关疾病的发生。子痫前期患者的胎盘和血清中可检测到一些差异性表达的mi RNA,这些mi RNA的靶基因直接参与了子痫前期的发生和发展。从mi RNA的角度在胎盘基因水平上揭示子痫前期的发病机制是目前研究的热点。mi RNA有望成为子痫前期预测和监测的生物标记物及其治疗的靶点。现对表达于胎盘,特别是与子痫前期相关的mi RNA及其靶基因功能的研究进展进行综述。     

硫酸镁治疗子痫前期的临床随机对照实验的Meta分析

目的:通过Meta分析对子痫前期应用硫酸镁治疗的效果和安全性进行评价,探讨子痫前期应用硫酸镁的指征.方法:检索2008年8月前的Medline医学数据库、SDOS全文数据库、中国期刊全文数据库公开发表应用硫酸镁治疗子痫前期的临床随机对照实验的全部文献,对入选的7篇文献使用Review Manager 4.2软件对实验数据进行合并分析.结果:对于重度子痫前期,实验组和对照组应用硫酸镁治疗后发展为子痫、产妇呼吸抑制、剖宫产率相比,差异均有统计学意义;对于轻度子痫前期,实验组和对照组应用硫酸镁治疗后发展为重度子痫前期、产妇感染、剖宫产率、新生儿Apgar评分比较,差异均无统计学意义(95%CI值包含1或WMD包含0).结论:对于重度子痫前期,应用硫酸镁可以显著降低子痫的发生;对于轻度子痫前期患者,应用硫酸镁预防或阻滞病情的发展没有显著的效果.