Diagnosis, prevention, and management of eclampsia
Diagnosis, prevention, and management of eclampsia
复制标题
DOI：
10.1097/01.aog.0000152351.13671.99
复制
发表时间：
2005-02-01
影响因子：
7.2
通讯作者：
Sibai, BM
中科院分区：
文献类型：
--
作者：
Sibai, BM
子痫性惊厥的发病机制仍不清楚。脑影像学提示子痫患者的脑异常（主要是血管源性水肿）与高血压性脑病相似。然而，脑成像是没有必要的诊断或管理大多数妇女与子痫。子痫性惊厥的发作可以在产前。(38-53%），产时。(18 36%），或产后（11-44%）。最近的数据显示，分娩后超过48小时发生子痫的妇女比例增加。除了先兆子痫的早期检测，没有可靠的测试或症状来预测子痫的发展。在发达国家，最近系列报告的大多数病例被认为是不可预防的。硫酸镁是降低分娩期和产后立即发生子痫的首选药物。有4项大型随机试验比较了硫酸镁与无治疗或安慰剂治疗重度厌食症前患者的效果。硫酸镁组的子痫发生率显著较低（0.6%对2.0%，相对危险度0.39，95%置信区间0.28 - 0.55）。因此，需要治疗以预防一例子痫的妇女人数为71人。硫酸镁是预防惊厥复发的首选药物。子痫的发生与母亲和胎儿不良结局的风险增加有关，特别是在发展中国家。妊娠并发子痫。需要一个精心设计的管理计划。有子痫史的妇女在随后的妊娠中发生子痫（1-2%）和先兆子痫（22-35%）的风险增加。根据最近的研究结果和我自己的临床经验，对这些妇女的诊断、预防、管理和咨询提出了建议。(C)2005年由美国妇产科医师学会。
The pathogenesis of eclamptic convulsions remains unknown. Cerebral imaging suggests that cerebral abnormalities in eclampsia (mostly vasogenic edema) are similar to those found in hypertensive encephalopathy. However, cerebral imaging is not necessary for the diagnosis or management of most women with eclampsia. The onset of eclamptic convulsions can be antepartum. (38 -53%), intrapartum. (18 36%), or postpartum (11-44%). Recent data reveal an increase in the proportion of women who develop eclampsia beyond 48 hours after delivery. Other than early detection of preeclampsia, there are no reliable tests or symptoms for predicting the development of eclarnpsia. In developed countries, the majority of cases reported in recent series are considered unpreventable. Magnesium sulfate is the drug of choice for reducing the rate of eclampsia developing intrapartum and immediately postpartum. There are 4 large randomized trials comparing magnesium sulfate with no treatment or placebo in patients with severe preedaxnpsia. The rate of eclampsia was significantly lower in those assigned to magnesium sulfate (0.6% versus 2.0%, relative risk 0.39, 95% confidence interval 0.28 - 0.55). Thus, the number of women needed to treat to prevent one case of eclampsia is 71. Magnesium sulfate is the drug of choice to prevent recurrent convulsions in eclampsia. The development of eclampsia is associated with increased risk of adverse outcome for both mother and fetus, Particularly in the developing nations. Pregnancies complicated by eclampsia. require a well-formulated management plan. Women with a history of eclampsia are at increased risk of eclampsia (1-2%) and preeclampsia (22-35%) in subsequent Pregnancies. Recommendations for diagnosis, prevention, management, and counseling of these women are provided based on results of recent studies and my own clinical experience. (C) 2005 by The American College of Obstetricians and Gynecologists.