Late postpartum eclampsia: A preventable disease?
Late postpartum eclampsia: A preventable disease?
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DOI：
10.1067/mob.2002.123824
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发表时间：
2002-06-01
影响因子：
9.8
通讯作者：
Sibai, BM
中科院分区：
文献类型：
--
作者：
Chames, MC;Livingston, JC;Sibai, BM
目的：本研究的目的是确定子痫发生时间是否与分娩有关，以及传统症状是否先于即将发生的产后子痫。研究设计：对1996年3月至2001年2月在辛辛那提大学、孟菲斯田纳西大学和列克星敦中央浸信会医院的子痫患者数据进行多中心分析。收集患者首次发作与分娩、前驱症状、神经影像学研究、硫酸镁使用、抗高血压治疗和随访医疗护理的关系数据。该分析主要集中在患有产后晚期子痫的妇女。结果：在研究期间，89例患者被诊断为子痫。29名妇女（33%）发生产后子痫，其中23名妇女（79%）晚发（48小时）。有趣的是，这23名女性中只有5名（22%）以前被诊断为子痫前期。21例（91%）产后晚期子痫患者至少有1种前驱症状，12例（52%）患者有预示癫痫发作的bbb1症状：20例（87%）患者有头痛；10名妇女（44%）有视力改变；5名女性（22%）出现恶心或呕吐；2名女性（9%）出现上腹部疼痛。在这21名妇女中，只有7名（33%）对她们的症状进行了治疗，其中6名（86%）有子痫前期的临床证据，但主治医生没有考虑到这一点。所有子痫患者中吸入性肺炎7例，肺水肿3例，胸腔积液3例，弥散性血管内凝血2例，无产妇死亡病例。结论：目前在美国的产科治疗已经导致子痫转移到产后时期，大多数病例被视为产后晚期。为了降低产后晚期子痫的发生率，应努力教育保健提供者和患者，使他们认识到在产后期间及时报告和评估子痫前期症状的重要性。
OBJECTIVE: The purpose of this study was to determine whether there is a shift in the timing of eclampsia in relation to delivery and whether traditional symptoms precede impending postpartum eclampsia.STUDY DESIGN: A multicenter analysis of data from patients with eclampsia from March 1996 through February 2001 at the University of Cincinnati, the University of Tennessee, Memphis, and Central Baptist Hospital, Lexington. Data were collected regarding the relationship of the patient's first seizure to delivery, prodromal symptoms, neuroimaging studies, use of magnesium sulfate, anti hypertensive therapy, and follow-up medical care. The analysis focused on women who had late postpartum eclampsia.RESULTS: During the study period, 89 patients were diagnosed with eclampsia. Twenty-nine women (33%) had postpartum eclampsia, of whom 23 women (79%) had late onset (>48 hours). Interestingly, only 5 of these 23 women (22%) had been previously diagnosed with preeclampsia. Twenty-one patients (91%) with late postpartum eclampsia had at least 1 prodromal symptom, and 12 patients (52%) had >1 symptom that heralded the seizure: 20 women (87%) had headache; 10 women (44%) had visual changes; 5 women (22%) had nausea or vomiting; and 2 women (9%) experienced epigastric pain. Only 7 of these 21 women (33%) sought care for their symptoms, of whom 6 women (86%) had clinical evidence of preeclampsia that was not considered by the treating physician. Among all patients with eclampsia, there were 7 cases of aspiration pneumonia, 3 cases of pulmonary edema, 3 cases of pleural effusion, 2 cases of disseminated intravascular coagulation, and no cases of maternal death.CONCLUSION: Current obstetric treatment in the United States has resulted in a shift of eclampsia toward the postpartum period, with most cases being seen as late post partum. To reduce the rate of late postpartum eclampsia, efforts should be directed to the education of the health care providers and patients regarding the importance of prompt reporting and evaluation of symptoms of preeclampsia during the postpartum period.