妊娠高血压和先兆子痫的诊断和处理.docxVIP

--------------------------------------------------------------- 最新资料推荐 ------------------------------------------------------ 妊娠高血压和先兆子痫的诊断和处理 妊娠高血压和先兆子痫的诊断和处理 Diagnosis and Managementof Gestational Hypertension and Preeclampsia Baha M. Sibai, MD Gestational hypertension and preeclampsia are common disorders during pregnancy, with the majority of cases developing at or near term. The development of mild hypertension or preeclampsia at or near term is associated with minimal maternal and neonatal morbidities. In contrast, the onset of severe gestational hypertension and/or severe preeclampsia before 35 weeks gestation is associated with significant maternal and perinatal complications. Women with diagnosed gestational hypertensionpreeclampsia require close evaluation of maternal and fetal conditions for the duration of pregnancy, and those with severe disease should be managed in-hospital. The decision between delivery and expectant managementdepends on fetal gestational age, fetal status, and severity of maternal condition at time of evaluation. Expectant management is possible in a select group of women with severe preeclampsia before 32 weeks gestation. Steroids are effective in reducing neonatal mortality and morbidity when administered to those with severe disease between 24 and 34 weeks gestation. 1 / 2 Magnesium sulfate should be used during labor and for at least 24 hours postpartum to prevent seizures in all womenwith severe disease. There is an urgent need to conduct randomized trials to determine the efficacy and safety of antihypertensive drugs in women with mild hypertensionpreeclampsia. There is also a need to conduct a randomized trial to determine the benefits and risks of magnesium sulfate during labor and postpartum in womenwith mild preeclampsia. (Obstet Gynecol 2003;102:18192. 2003 by The American College of Obstetricians and Gynecologists.) Hypertension is the most common medical disorder during pregnancy.1 Approximately 70% of