Hypertension in pregnancy.

S. Meher, J. Neilson
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Abstract

Formal assessment of the risk of pre-eclampsia should be made early in pregnancy and antenatal care planned accordingly. Recommendations will emerge by the end of this year in a consensus statement (PRECOG guidelines) prepared by clinicians and the lay organisation Action on Pre-eclampsia (APEC) www.apec.org.uk. Some hospitals complement clinical risk assessment with Doppler screening of uterine artery waveforms in mid-pregnancy. Severe pre-eclampsia often takes an explosive course, evolving over a period of hours. Recognition may, therefore, not be amenable to intermittent blood pressure recording and urine testing, but requires women reporting relevant symptoms and GPs being sensitive to the possible significance of complaints such as vomiting and epigastric pain. Severe hypertension demands urgent antihypertensive treatment in hospital. Magnesium sulphate now has an accepted role in the prevention of eclampsia. Possible prevention of pre-eclampsia by antioxidant therapy is the subject of a clinical trial. Low-dose aspirin has a modest but beneficial effect in high-risk women. Delivery remains the definitive treatment for pre-eclampsia, but there may be initial deterioration after birth, especially in the HELLP syndrome.
妊娠期高血压。
应在妊娠早期对先兆子痫的风险进行正式评估,并制定相应的产前护理计划。建议将在今年年底出现在由临床医生和非专业组织行动先兆子痫(APEC) www.apec.org.uk准备的共识声明(PRECOG指南)中。一些医院在妊娠中期对子宫动脉波形进行多普勒筛查,作为临床风险评估的补充。严重的先兆子痫通常是一个爆炸性的过程,在一段时间内发展。因此,间歇性的血压记录和尿液检测可能无法进行诊断,但需要妇女报告相关症状,全科医生对呕吐和胃脘痛等主诉的可能意义敏感。重度高血压需要紧急住院降压治疗。硫酸镁现在在预防子痫方面有公认的作用。抗氧化治疗预防先兆子痫的可能性是一项临床试验的主题。小剂量的阿司匹林对高危女性有适度但有益的作用。分娩仍然是先兆子痫的最终治疗方法,但出生后可能会出现最初的恶化,特别是在HELLP综合征中。
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