immune theory

Inadequate recasting of uterine spiral arterioles

endothelial dysfunction

Nutritional deficiencies and other factors

First hypertension after 20 weeks of pregnancy, BP ≥ 140/90mmHg, and returns to normal within 12 weeks after delivery; urine protein (-); the patient may be accompanied by upper abdominal discomfort or thrombocytopenia

Mild

Severe

Convulsive seizures or coma may occur on the basis of preeclampsia. Eclampsia is divided into prepartum eclampsia, intrapartum eclampsia, and postpartum eclampsia, with prepartum eclampsia being the most common.

Pregnant women with high blood pressure have no proteinuria before 20 weeks of gestation. If urine protein ≥0.3g/24h or random urine protein ≥ ( ) appears after 20 weeks of pregnancy; or if urine protein suddenly increases after 20 weeks of pregnancy, blood pressure further rises, or Thrombocytopenia (<100x10^9/L).

Blood pressure ≥140/90mmHg before pregnancy or before 20 weeks of pregnancy, but not significantly aggravated during pregnancy; or hypertension is first diagnosed after 20 weeks of pregnancy and continues beyond 12 weeks postpartum.

Ask whether there are high-risk factors for hypertension during pregnancy; whether there is a history of hypertension, chronic nephritis, diabetes, etc.; whether there is high blood pressure, proteinuria, edema, headache, visual impairment, epigastric discomfort, convulsions, etc. during this pregnancy. symptom.

Typical symptoms include hypertension, proteinuria, and edema. Conscious symptoms, convulsions, coma and other conditions; assess whether there are complications.

Routine urine examination

blood test

Liver and kidney function test

Fundus examination

Should be hospitalized. The principles of treatment are antispasmodic, sedative, antihypertensive, reasonable volume expansion and diuresis, and timely termination of pregnancy to prevent complications. Magnesium sulfate is the first choice for antispasmodic treatment. If preeclampsia does not improve significantly after 24 to 48 hours of active treatment, the pregnancy should be terminated in time. Patients with eclampsia should quickly control the extraction, correct hypoxia and acidosis, and terminate the pregnancy 2 hours after the extraction is controlled.

Strengthen rest: rest for at least 10 hours a day, preferably in the left lying position.

Reasonable diet: Adequate intake of protein and calories, no restriction on salt and fluids, but salt intake should be appropriately limited for patients with generalized edema.

Reasonable use of sedatives: Give appropriate sedatives as directed by your doctor.

Intermittent oxygen inhalation: Intermittent oxygen inhalation as directed by the doctor.

Closely monitor the status of mother and child: strengthen prenatal examinations, pay attention to pregnant women's subjective symptoms, and measure weight and blood pressure every day. Regularly monitor fetal development and placental function, guide pregnant women to count fetal movements every day, and listen to fetal heartbeat frequently.

Usage: Use slow intravenous infusion or deep intramuscular injection, and follow the doctor’s instructions to use the medication correctly.

Toxic reactions: First, the knee reflex weakens or disappears

Things to note

Control convulsions: magnesium sulfate is the drug of choice

Avoid stimulation that may induce convulsions

Special care by dedicated personnel to prevent injuries

Close supervision

Be prepared to terminate your pregnancy

Vaginal delivery patients need to strengthen care during each stage of labor and shorten the second stage of labor as much as possible. In order to avoid maternal exertion, first-time mothers may consider assisted vaginal delivery. Postpartum blood pressure still needs to be monitored. Severe patients still have the possibility of postpartum eclampsia, and magnesium sulfate treatment should be continued. 1 to 2 days; mothers who use large amounts of magnesium sulfate are prone to uterine atony after delivery, and should closely observe the involution of the uterus to prevent postpartum hemorrhage.

Supplement 1~2g of calcium daily starting from the 20th week of pregnancy; try to choose a second pregnancy one year after normal blood pressure to prevent recurrence of the disease.

It is related to the inferior vena cava being compressed by the enlarged uterus, which blocks blood return, or is related to malnutrition and hypoalbuminemia.

associated with eclampsia

placental abruption