The risk factors for labor onset hypertension
The risk factors for labor onset hypertension
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DOI：
10.1038/hr.2015.112
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发表时间：
2016-04-01
影响因子：
5.4
通讯作者：
Saito, Shigeru
中科院分区：
文献类型：
--
作者：
Ohno, Yasumasa;Terauchi, Mikio;Saito, Shigeru
我们的目的是澄清在分娩后首次检测到的高血压的围产儿结局和危险因素（分娩高血压，LOH），这可能是分娩期间子痫和中风的危险因素。共有1349名分娩前未表现出子痫前期或妊娠高血压的孕妇接受了检查。将患者分为4组：正常血压组（n = 1023）（整个分娩过程中收缩压（SBP）保持在140 mm Hg以下）、轻度LOH组（n = 241）（分娩过程中最大收缩压在140 ~ 159 mm Hg之间）、重度LOH组（n = 66）（分娩过程中最大收缩压在160 ~ 179 mm Hg之间）和紧急LOH组（n = 19）（分娩过程中最大收缩压大于180 mm Hg）。比较四组的围产儿结局及患者特点。在怀孕期间血压保持正常的孕妇中，24%的人在分娩时患上了高血压。紧急LOH组1例发生子痫。四组患者分娩时血压、降压药使用频率、介入分娩和低Apgar评分差异显著。提取严重/紧急LOH的以下危险因素：年龄超过35岁，分娩时体重指数430，妊娠36周收缩压130-134毫米汞柱，入院时收缩压130-139毫米汞柱，蛋白尿（油尺试验得分2+）和严重水肿。本研究确定了严重/紧急LOH的危险因素。在高危病例中，分娩期间反复测量产妇血压可能有助于早期发现危重性高血压。
Our aim was to clarify the perinatal outcomes of and risk factors for hypertension that is first detected after labor onset (labor onset hypertension, LOH), which may be a risk factor for eclampsia and stroke during labor. A total of 1349 parturient women who did not exhibit preeclampsia or gestational hypertension prior to labor were examined. The patients were classified into four groups: the normotensive (n = 1023) (whose systolic blood pressure (SBP) remained below 140 mm Hg throughout labor), mild LOH (n = 241) (whose maximum SBP during labor ranged from 140 to 159 mm Hg), severe LOH (n 66) (whose maximum SBP during labor ranged from 160 to 179 mm Hg) and emergent LOH groups (n 19) (whose maximum SBP during labor was greater than 180 mm Hg). The perinatal outcomes and patient characteristics of the four groups were compared. Twenty-four percent of the pregnant women who remained normotensive throughout pregnancy developed hypertension during labor. One of the patients in the emergent LOH group developed eclampsia. The blood pressure at delivery and frequencies of hypotensor use, interventional delivery and low Apgar scores differed significantly among the four groups. The following risk factors for severe/emergent LOH were extracted: being over 35 years old, a body mass index at delivery of 430, an SBP at 36 weeks' gestation of 130-134 mm Hg, an SBP at admission of 130-139 mm Hg, proteinuria (a score of 2+ on the dipstick test) and severe edema. The risk factors for severe/emergent LOH were identified in this study. In high risk cases, repeatedly measuring maternal blood pressure during delivery might help detect critical hypertension early.