Postpartum management of hypertensive disorders of pregnancy: a systematic review.
Postpartum management of hypertensive disorders of pregnancy: a systematic review.
复制标题
DOI：
10.1136/bmjopen-2017-018696
复制
发表时间：
2017-11-28
期刊：
影响因子：
2.9
通讯作者：
McManus RJ
中科院分区：
文献类型：
--
作者：
Cairns AE;Pealing L;Duffy JMN;Roberts N;Tucker KL;Leeson P;MacKillop LH;McManus RJ
妊娠期高血压疾病（HDP）影响十分之一的妊娠，并经常持续产后并发症时可能发生。我们的目的是确定药物干预、其他干预和不同护理模式对产后高血压管理的有效性和安全性。进行了系统审查。从开始到2017年3月16日，检索了9个电子数据库，包括Medline。删除重复项后，筛选了4561条记录。两位作者独立选择研究，提取研究特征和数据，并评估方法学质量。来自任何国家和医疗机构的随机对照试验、病例对照研究和队列研究。患有HDP的产后妇女。高血压管理的治疗性干预与另一种干预、安慰剂或无干预相比。收集了孕产妇死亡率和严重发病率的结局数据;收缩压、舒张压和平均动脉压（BP）控制;以及安全性数据。收集的次要结果数据包括产后住院时间和实验室检查值。纳入39项研究（n=2901）。结果是异质性的干预，比较和结果需要一个叙述的方法。没有足够的数据推荐任何单一的药物干预。18项研究报告了钙通道阻滞剂、血管扩张剂和β受体阻滞剂降低产后血压。其中12例报告了安全性数据。出院后数周内关于管理的数据有限。袢利尿剂（3项研究）和皮质类固醇（1项研究）均未产生临床获益。与标准护理相比，刮宫术在产后前48小时内显著降低了血压（范围6-13 mm Hg）（8项研究），8项研究中仅4项报告了安全性数据。没有足够的证据推荐特定的血压阈值、药物或护理模式，但三类抗高血压药物似乎效果不佳。需要进一步的比较研究，包括可靠的安全性数据。刮宫术降低了血压，但没有充分的危害报告，因此目前不能推荐。
Hypertensive disorders of pregnancy (HDP) affect one in ten pregnancies and often persist postpartum when complications can occur. We aimed to determine the effectiveness and safety of pharmacological interventions, other interventions and different care models for postpartum hypertension management. A systematic review was undertaken. Nine electronic databases, including Medline, were searched from inception to 16 March 2017. After duplicate removal, 4561 records were screened. Two authors independently selected studies, extracted study characteristics and data, and assessed methodological quality. Randomised controlled trials, case–control studies and cohort studies from any country and healthcare setting. Postnatal women with HDP. Therapeutic intervention for management of hypertension, compared with another intervention, placebo or no intervention. Outcome data were collected for maternal mortality and severe morbidity; systolic, diastolic and mean arterial blood pressure (BP) control; and safety data. Secondary outcome data collected included the length of postnatal hospital stay and laboratory values. 39 studies were included (n=2901). Results were heterogeneous in terms of intervention, comparison and outcome requiring a narrative approach. There were insufficient data to recommend any single pharmacological intervention. 18 studies reported calcium-channel blockers, vasodilators and beta-blockers lowered BP postpartum. 12 of these reported safety data. Limited data existed regarding management in the weeks following hospital discharge. Neither loop diuretics (three studies) nor corticosteroids (one study) produced clinical benefit. Uterine curettage significantly reduced BP over the first 48 hours postpartum (range 6–13 mm Hg) compared with standard care (eight studies), with safety data only reported by four of eight studies. There was insufficient evidence to recommend a particular BP threshold, agent or model of care, but three classes of antihypertensive appeared variably effective. Further comparative research, including robust safety data, is required. Curettage reduced BP, but without adequate reporting of harms, so it cannot currently be recommended.
登录
查看更多内容
影响因子：
7.2
作者：
Barrilleaux, PS;Martin, JN;May, WL
通讯作者：
May, WL
影响因子：
9.8
作者：
Chames, MC;Livingston, JC;Sibai, BM
通讯作者：
Sibai, BM
DOI：
10.1016/0002-9378(90)91011-z
发表时间：
1990-03-01
影响因子：
9.8
作者：
BARTON, JR;HIETT, AK;CONOVER, WB
通讯作者：
CONOVER, WB
影响因子：
7.2
作者：
Berks, Durk;Steegers, Eric A. P.;Fisser, Willy
通讯作者：
Fisser, Willy
影响因子：
7.2
作者：
Ascarelli, MH;Johnson, V;Martin, JN
通讯作者：
Martin, JN