其他疾病误诊为妊娠期高血压疾病原因分析

Analysis of Causes of Misdiagnosis of Other Diseases as Hypertensive Diseases During Pregnancy

目的探讨其他疾病误诊为妊娠期高血压疾病(HDP)的原因及防范措施。方法回顾分析2017年2月—2021年10月收治的4例误诊为HDP患者的临床资料。结果4例以妊娠期尿蛋白阳性、血压升高、抽搐为主要症状就诊,均误诊为HDP。1例因怀疑重度子痫前期并发胎盘早剥而行急诊剖宫产术,产后诊断为妊娠期慢性肾炎。1例入院诊断重度子痫前期,因降压药无效,怀疑妊娠期嗜铬细胞瘤,进一步查肾上腺素、去甲肾上腺素升高,超声及MRI检查发现肾上腺肿块影或信号,明确诊断为妊娠期嗜铬细胞瘤,因胎儿窘迫行急诊剖宫产术,术后行嗜铬细胞瘤切除术。1例因拟诊子痫行急诊剖宫产术,产后诊断为妊娠期癫痫。1例拟诊重度子痫前期,经降压治疗血压控制不显著,后经追问病史及行甲状腺功能检查明确诊断为妊娠期甲状腺功能亢进症,联合药物治疗后症状缓解,回家待产。结论产前误诊为HDP会导致过度治疗及治疗不当,使得剖宫产率及胎儿早产率升高,增加围生儿不良结局风险。产科医生应加强对HDP临床特点的认识及认真鉴别诊断,仔细询问患者妊娠前及妊娠期病史,并及时完善相关检查,提高HDP正确诊断率,避免孕产妇及围生儿的不良结局。

Objective To explore the causes of misdiagnosis and preventive measures of other diseases as hypertensive disorders during pregnancy(HDP).Methods The clinical data of 4 patients diagnosed with HDP from February 2017 to October 2021 were retrospectively analyzed.Results The main symptoms of the 4 cases were positive urine protein,elevated blood pressure and convulsion,all of which were misdiagnosed as HDP.One case was diagnosed with chronic nephritis during pregnancy after caesarean section due to suspected severe preeclampsia complicated with placental abruption.One case was admitted to hospital and diagnosed with severe preeclampsia.Due to the inefficacy of antihypertensive drugs,pheochromocytoma was suspected during pregnancy.After further examination of elevated adrenaline and norepinephrine,ultrasound and MRI examination found adrenal mass or signal,and the diagnosis was confirmed as pheochromocytoma during pregnancy.One case underwent emergency caesarean section due to eclampsia,and was diagnosed as pregnancy epilepsy after delivery.One case was suspected to have severe preeclampsia,and the blood pressure was not significantly controlled after antihypertensive treatment.After inquiry about medical history and thyroid function test,the patient was diagnosed as hyperthyroidism during pregnancy.After combined drug treatment,the symptoms were relieved and she returned home to await delivery.Conclusion Prenatal misdiagnosis of HDP can lead to over-treatment and improper treatment,increase the rate of cesarean section and preterm birth rate,and increase the adverse outcome of perinatal infants.Obstetricians should strengthen their understanding of the clinical characteristics and differential diagnosis of HDP,carefully inquire about the medical history of patients before and during pregnancy,and timely improve the corresponding examination,so as to improve the correct diagnosis rate of HDP and avoid adverse outcomes of pregnant women and perinatal infants.