The Guidelines for the Diagnosis and Treatment of Hypertension in Pregnancy (2020) are revised on the basis of the 2015 version of the guidelines. In the latest version of the guidelines,Clearly emphasized the complexity of the onset of hypertension in pregnancy in pregnant women,In particular, the clinical manifestations and manifestations of hypertension in pregnant women are complex, and the first symptoms of preeclampsia are diverse. On this basis, the guidelines emphasize the identification of various risk factors, and propose that the clinical warning information during pregnancy should be emphasized, prenatal examinations should be strengthened, early recognition and early diagnosis capabilities should be improved, and the basis for symptomatic treatment such as blood pressure reduction and prevention of convulsions On the top, pay attention to the diagnosis and treatment of various induced causes, and the following is for some updates.

1) How to investigate and screen risk factors early

2) How to do early prevention and warning

3) How to diagnose, intervene and deal with it early

Not every case of pregnant women with preeclampsia has all risk factors, and most preeclampsia is seen in so-called "healthy" pregnant women who have no obvious risk factors. The risk factors for the onset of preeclampsia are shown in Table 1.

 

 

Note: The yellow mark represents adjustment (adjusted to 35 years old from 40) or increase.

It is very important to emphasize the pre-pregnancy check-ups and pre-natal check-ups of the risk population.

Pay attention to the investigation of various risk factors, and pay attention to those who are underweight.

● Blood pressure measurement method: increase the blood pressure of both arms when necessary to understand the increase in blood pressure;

● Blood pressure measurement method: increase the blood pressure of both arms when necessary to understand the increase in blood pressure;

1. Persistent severe hypertension (hypertensive emergency): systolic blood pressure ≥160mmHg and/or diastolic blood pressure

2. ≥110mmHg, for severe hypertension, such as acute onset, continuous >15 min dynamic monitoring, evaluation and management of "white coat hypertension", occult hypertension and transient or transient hypertension and other manifestations of hypertension ；

3. Close follow-up blood pressure is 30/15mmHg higher than basal blood pressure, but less than 140/90 mmHg (not used as a diagnostic basis for hypertension), pay attention to relative hypertension;

4.For "white coat hypertension", occult hypertension, transient or transient hypertension, and relative hypertension, pay attention to the changes of ambulatory blood pressure. It is recommended to monitor blood pressure at home and 24h ambulatory blood pressure monitoring for those who have the right conditions.

1. When there is early preeclampsia or clinical manifestations similar to preeclampsia before 20 weeks of pregnancy, it is necessary to promptly contact with autoimmune disease, thrombotic thrombocytopenic purpura (TTP), kidney disease, trophoblastic disease, hemolytic uremic Syndrome identification;

2. Hypertension during pregnancy without proteinuria is more likely to manifest as thrombocytopenia and impaired liver function;

3. Attention should be paid to distinguishing hypertension during pregnancy with proteinuria from kidney disease and autoimmune disease;

4. If the condition does not alleviate after childbirth, attention should be paid to whether there is hemolytic uremic syndrome;

5. Pay attention to the differentiation of eclampsia and posterior reversible encephalopathy syndrome (PRES) from epilepsy, other causes of cerebral artery ischemia or infarction, and intracranial hemorrhage.

● Pre-eclampsia-eclampsia has multiple factors, which also makes the clinical manifestations diverse and complex. Individuals have different first symptoms.

● First symptoms: single elevated blood pressure, single proteinuria, fetal growth restriction, decreased platelets, headache or visual disturbance, epigastric pain, hyperreflexia, headache or visual impairment coexist with epigastric pain.

● There are only abnormal laboratory test indicators, platelet count <100×109/L, abnormal transaminase level (such as ALT≥70U/L, blood creatinine level>106μmol/L, hypoproteinemia, etc.).

1) Note: Some pregnant women do not have high blood pressure or proteinuria at the onset of preeclampsia.

2) Note that the clinical manifestations of preeclampsia are gradual or rapid, and may even deteriorate rapidly within 2-3 days.

3) Pre-eclampsia-eclampsia can develop in leaps and bounds clinically. Not all gradual development. Eclampsia can occur on the basis of the clinical manifestations of pre-eclampsia, can occur in severe patients, or can occur in clinically undetected hypertension and When proteinuria.

A large number of studies have verified that angiogenic factors, such as sFlt-1, PLGF, and sEng, can play a role in the prediction of early-onset preeclampsia in the second trimester.

In addition, the 2020 version of the guidelines recognizes that the best prediction method recommended in the 2019 ``FIGO Preeclampsia Early Preeclampsia Screening and Prevention Practical Guidelines'' isThe risk factors of pregnant women are combined with MAP, PLGF, and UTPI, and the accuracy is higher.Of course, with regard to the combined application of biomarkers to predict preeclampsia and how to combine with other biophysical parameters, it is necessary to carry out prospective, large-sample multi-center studies in accordance with China's national conditions to formulate China's plans.

1. Appropriate prenatal checkups should be performed

2. Carry out adequate diet and nutrition management

3. Improve the quality of prenatal care

4.Strengthen the improvement of pregnant women's self-adherence

5. For people with low calcium intake (<600 mg/d), the recommended oral calcium supplement is at least 1 g/d.

6. Aspirin prevention: pregnant women with high risk factors for preeclampsia, start to take a small dose of aspirin (50-150mg) every day from the early and second trimester of pregnancy (12-16 weeks of gestation), and determine the duration of medication according to individual factors. Preventive application can be maintained until pregnancy 26-28 week.