妊娠期高血压疾病的处理

Management of hypertensive disorders in pregnancy

妊娠期高血压疾病(HDP)是妊娠期常见的以高血压、肾功能损害、神经系统症状为主要表现的严重临床综合征,是导致妊娠期死亡的首要原因。根据2013美国妇产科医师协会指南HDP可分为妊娠期高血压、子痫前期-子痫、慢性高血压及慢性高血压并发子痫前期。妊娠期血压≥160/110 mm Hg应给予降压治疗。钙离子拮抗剂、交感神经抑制剂应作为降压药物的首选,由于肾素血管紧张素受体抑制剂的潜在致畸性不建议早期使用。单纯子痫前期患者可给予期待治疗,包括降压、对症和营养支持等。妊娠期高血压疾病通常在分娩12周内自发缓解,如持续存在,应诊断慢性高血压,特别是分娩6个月后仍有蛋白尿的患者,建议行肾活检明确是否患有慢性肾脏疾病。

Hypertensive disorders in pregnancy (HDP)is a common and serious clinical syndrome, characterized by hypertension,renal injury,and neurological symptoms in pregnancy,and is a major cause for maternal death.According to 201 3 ACOG (American College of Obstetricians and Gynecologists) guideline,HDP is categorized as gestational hypertension,preeclamsia-eclamsia,chronic hypertension,and chronic hypertension complicated with preeclamsia.Patients with blood pressure of ≥1 60 /1 1 0 mmHg need antihypertensive therapy of which the first-line drugs are calcium channel blockers and adrenoceptor blocking agents.Renin and angiotensin receptor blockers are contraindicated in the first trimester of pregnancy due to their potential teratogenicity. Patients with mild preeclampsia are suggested to receive expectant management,including antihypertensive medication,symptomatic treatment,and nutritional supportive treatment.HDP has a tendency to spontaneous remission within 1 2 weeks after delivery.Diagnosis of chronic hypertension is considered if hypertension persists.Renal biopsy should be advised to investigate the underlying chronic kidney disease if proteinuria persists more than six months after delivery.