Preeclampsia into eclampsia: Toward a new paradigm
Preeclampsia into eclampsia: Toward a new paradigm
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DOI：
10.1067/mob.2000.106178
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发表时间：
2000-06-01
影响因子：
9.8
通讯作者：
Kuller, JA
中科院分区：
文献类型：
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作者：
Katz, VL;Farmer, R;Kuller, JA
目的：本研究旨在描述子痫自然史的各个方面。研究设计：对在两家三级医院分娩的子痫患者的记录进行回顾性分析。结果：确定了 53 例并发子痫的妊娠。其中三十七名妇女未生育过。平均年龄为 22 岁（范围为 15-38 岁）。癫痫发作时的平均孕周为 34.2 周（范围为 22-43 周）。 28 名女性有产前癫痫发作（53%）； 28 人中有 23 人在家中癫痫发作。 19 名女性有产时癫痫发作（36%）。其中 8 名女性在接受硫酸镁治疗时出现癫痫发作，7 名女性的镁水平达到治疗水平。 6 名女性 (11%) 在产后 24 小时内出现产后癫痫发作。 34 例中，头痛先于癫痫发作。 16 例患者癫痫发作前出现视觉障碍。 43 名女性的尿酸水平升高至 >6 mg/dL。没有孕产妇死亡或永久性发病。围产儿死亡 4 例。两名患者在妊娠 28 周和 36 周时发生宫内胎儿死亡。这些母亲在家中癫痫发作。一名婴儿在妊娠 22 周时死于早产并发症，一名婴儿在妊娠 26 周时死于呼吸道并发症。胎盘早剥4例，其中1例导致胎儿死亡。在 53 例子痫病例中，只有 9 例是可以预防的。其中之一是一名在家中受到观察的妇女。另外8名女性因高血压和蛋白尿入院治疗。只有 7 名女性在癫痫发作前可被认为患有严重先兆子痫 (13%)，而这 7 名女性中有 4 名正在接受硫酸镁治疗。 结论：未发现子痫是严重先兆子痫的进展。 53 例中有 32 例 (60%) 癫痫发作是先兆子痫的最初症状。在这个系列中，子痫似乎更像是先兆子痫的一个子集。按照目前的实践标准，只有 9 例子痫是可以预防的。我们针对这种疾病的范例以及我们预防癫痫发作的方法应该重新评估。
OBJECTIVE: This study was undertaken to characterize aspects of the natural history of eclampsia.STUDY DESIGN: A retrospective analysis was performed on the records of patients with eclampsia who were delivered at two tertiary care hospitals.RESULTS: Fifty-three pregnancies complicated by eclampsia were identified. Thirty-seven of the women were nulliparous. The mean age was 22 years (range, 15-38 years). Mean gestational age at the time of seizures was 34.2 weeks' gestation (range, 22-43 weeks' gestation). Twenty-eight women had antepartum seizures (53%); 23 of the 28 had seizures at home. Nineteen women had intrapartum seizures (36%). Eight of these women had seizures while receiving magnesium sulfate, and 7 had therapeutic magnesium levels. Six women had postpartum seizures (11%), 4 >24 hours after delivery. Headache preceded seizures in 34 cases. Visual disturbance preceded seizures in 16 cases. The uric acid level was elevated to >6 mg/dL in 43 women. There were no maternal deaths or permanent morbidities. There were 4 perinatal deaths. Two patients had intrauterine fetal deaths at 28 and 36 weeks' gestation. These mothers had seizures at home. One infant died of complications of prematurity at 22 weeks' gestation and one died of respiratory complications at 26 weeks' gestation. There were 4 cases of abruptio placentae, 1 of which resulted in fetal death. Of the 53 cases of eclampsia, only 9 were potentially preventable. One of these was that of a woman who was being observed at home. The other 8 women were hospitalized and had hypertension and proteinuria. Only 7 women could be considered to have severe preeclampsia before seizure (13%), and 4 of these 7 women were receiving magnesium sulfate.CONCLUSIONS: Eclampsia was not found to be a progression from severe preeclampsia. In 32 of 53 cases (60%) seizures were the first signs of preeclampsia. In this series eclampsia appeared to be more of a subset of preeclampsia. Only 9 cases of eclampsia were potentially preventable with current standards of practice. Our paradigm for this disease, as well as our approach to seizure prophylaxis, should be reevaluated.