The treatment of hypertension in pregnancy
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- 作者：Umbareen Siddiqi ; Felicity Plaat
- 关键词：Hypertension ; labetalol ; magnesium sulphate ; methyldopa ; pre-eclampsia ; pregnancy ; proteinuria ; regional anaesthesia
- 刊名：Anaesthesia & Intensive Care Medicine
- 出版年：2017
- 出版时间：February 2017
- 年：2017
- 卷：18
- 期：2
- 页码：106-109
- 全文大小：207 K
- 卷排序：18
文摘
Maternal deaths from complications of pregnancy; so-called ‘direct deaths’, including hypertensive disorders, are now less than from indirect causes, (medical conditions that may be exacerbated by pregnancy). The direct death rate in the UK has fallen significantly over the past 5 years. The death rate from hypertensive disorders is at its lowest ever: 0.25/100 × 103 maternities [95%CI 0.09–0.55]. In other words there is one death from hypertensive disorders for every 400,000 maternities. Having been one of the leading direct causes of maternal mortality, it now lags behind thromboembolic disease, haemorrhage and amniotic fluid embolism. This improvement is likely to reflect careful management not a fall in incidence as hypertensive disorders remain one of the commonest complications of pregnancy.The precise trigger for pre-eclampsia has yet to be elucidated but the pathophysiology involves abnormal placentation and an exaggerated inflammatory response causing a multisystem disorder. Raised or rising blood pressure in a pregnant woman should alert the clinician to look for the development of pre-eclampsia. Diagnosis and treatment of hypertensive disorders in pregnancy is vital they are associated with both a worse maternal and fetal outcome. Current recommendations suggest that all pregnant women with a systolic blood pressure greater than 160 mmHg should have immediate antihypertensive therapy and treatment should be initiated at lower pressures if the overall clinical picture suggests rapid deterioration. Regional anaesthesia is recommended for both labour analgesia and operative delivery. In the presence of compromised placental function and intrauterine growth restriction, regional blockade has the beneficial effect of improving placental blood flow.