SOME OBSERVATIONS ON THE INCIDENCE OF PRE‐ECLAMPSIA
SOME OBSERVATIONS ON THE INCIDENCE OF PRE‐ECLAMPSIA
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DOI：
10.1111/j.1471-0528.1958.tb08557.x
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发表时间：
1958-08
期刊：
影响因子：
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通讯作者：
I. Macgillivray
中科院分区：
文献类型：
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作者：
I. Macgillivray
许多人认为，母亲在怀孕期间的饮食对先兆子痫的发病率有很大影响。为了支持这一观点，有人指出，由于饮食习惯的差异，世界各地的先兆子痫发病率差异很大。在检查此类陈述的准确性之前，必须就先兆子痫的定义达成国际共识，然后对具有不同饮食习惯的明确定义的人群进行流行病学研究。不幸的是，由于先兆子痫很难定义，因此这样做存在很大的实际困难。在某些方面研究子痫的发病率会更容易，但这通常可以通过良好的产前护理来预防，因此不同的发病率更有可能衡量产前护理的效率，而不是更一般的环境条件的影响。先兆子痫通常不会引起任何症状，许多轻症病例不会入院。因此，在所有情况下都需要在整个怀孕期间仔细测量血压。理想情况下，应了解患者的孕前血压，或者至少了解妊娠前三个月的血压，即先兆子痫开始影响血压之前的血压。相当大一部分人直到妊娠中期才向家庭医生或医院产前诊所报告，因此在这些情况下，人们无法确定是否在怀孕期间出现了高血压。另一个困难是，在区域调查中，测量血压的技术差异很大，可能在某种程度上使得出的结论无效。本文研究了 1948-55 年间在阿伯丁妇产医院预约的初产妇中先兆子痫的发病率。由于超过 90% 的阿伯丁初产妇都被隔离在医院，因此接受审查的群体在该市所有初产妇中具有相当的代表性。由于许多患者到诊所就诊较晚，因此并不总是能够区分轻度先兆子痫和已有的高血压。因此，使用了在该诊所工作的 Nelson (1 955) 使用的先兆子痫的定义。他将先兆子痫描述为舒张压升高至 90 毫米的病症。怀孕第 26 周后，两次出现汞含量或更高含量，相隔至少一天；如果在分娩期间出现汞含量升高，则呈进行性模式。然而，读数之间的间隔不应太长，否则无法推断出明确的关系。轻度的情况下，没有蛋白尿，除非是轻微的或短暂的。在“严重”先兆子痫中，除了血压升高之外，还存在超过 0-25 克/升 (Esbach) 的蛋白尿，最好是尿导管样本中的蛋白尿。虽然水肿通常是先兆子痫综合征的一部分，但出于定义和分类的目的，它被忽略，因为没有令人满意的方法来评估水肿程度，并且经常发现下肢肿胀而没有任何先兆子痫的其他证据。此外，常规产前诊所通常不会对水肿进行客观测量，并且不同观察者的临床印象记录很少是一致或可靠的。纳尔逊对先兆子痫的定义
MANY believe that the mother’s diet during pregnancy greatly influences the incidence of pre-eclampsia. In support of this point of view it is stated that the incidence of pre-eclampsia varies greatly from one part of the world to another coinciding with differences in dietary habits. Before the accuracy of such statements could be checked international agreement would have to be reached concerning the definition of preeclampsia followed by epidemiological studies of clearly defined populations with differing food habits. Unfortunately there are great practical difficulties in doing this since pre-eclampsia is difficult to define. It would be easier in some ways to study the incidence of eclampsia but this can usually be prevented by good antenatal care so that a varying incidence is more likely to be a measure of the efficiency of antenatal care than of the effect of more general environmental conditions. Pre-eclampsia often causes no symptoms and many mild cases are not admitted to hospital. Careful blood pressure readings through pregnancy are therefore required in all cases. Ideally the patient’s pre-pregnancy blood pressure should be known or at least the pressure in the first trimester, that is before pre-eclampsia has begun to affect it. Quite a large proportion do not report to their family doctor or to a hospital antenatal clinic until well into the second trimester so that in these cases one cannot be sure that any hypertension found has arisen during the pregnancy. Another difficulty is that in a regional survey great variations in the technique of taking the blood pressure may invalidate to some extent conclusions drawn. The present paper is a study of the incidence of pre-eclampsia in booked primigravidae in the Aberdeen Maternity Hospital during the years 1948-55. Since more than 90 per cent of all Aberdeen primigravidae are confined in hospital the group under review is fairly representative of all primigravidae in the City. As a number of patients presented themselves at the clinic rather late it was not always possible to distinguish between mild pre-eclampsia and pre-existing hypertension. The definition of preeclampsia used by Nelson (1 955) working in this clinic has therefore been used. He described preeclampsia as a condition in which a rise of diastolic blood pressure to 90 mm. of mercury or higher occurred after the 26th week of pregnancy on two occasions separated by at least one day or showed a progressive pattern if the rise occurred in labour. The interval between the readings should not, however, be so long that a definite relationship cannot be inferred. In the mild form, there is no albuminuria, unless of a trivial or transitory kind. In “severe” preeclampsia, in addition to the raised blood pressure there is albuminuria exceeding 0-25 g./litre (Esbach), preferably in a catheter specimen of urine. Although oedema is commonly part of the pre-eclamptic syndrome, it is ignored for the purposes of definition and classification, since there is no satisfactory method of assessing degrees of oedema, and some swelling of the lower limbs is frequently found without any other evidence of pre-eclampsia. Furthermore, objective measurements of oedema are not usually undertaken in routine antenatal clinics and records of the clinical impressions of different observers are seldom consistent or reliable. Nelson’s definition of pre-eclampsia