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School of Diagnostics|Guidelines for interpretation and prediction of pregnancy-induced hypertension and preeclampsia

School of Diagnostics|Guidelines for interpretation and prediction of pregnancy-induced hypertension and preeclampsia

(Summary description)

School of Diagnostics|Guidelines for interpretation and prediction of pregnancy-induced hypertension and preeclampsia

(Summary description)

 
 

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Hypertension in pregnancy is one of the most important causes of maternal and perinatal death worldwide. Due to its wide impact, high incidence of adverse pregnancy outcomes, and high medical costs, hypertension in pregnancy has always been a global obstetrician The focus of the doctor's attention.

 

 

2019 version of ACOG

Guidelines for hypertension and preeclampsia during pregnancy

 

 

With the implementation of the two-child policy in my country, the aging of pregnant women and the younger generation of cardiovascular diseases, the clinical treatment and management of these patients are facing huge challenges. Experts in obstetrics and gynecology and cardiovascular diseases at home and abroad have launched a series of management guidelines through continuous research and exploration of pregnancy-induced hypertension. It is helpful for the blood pressure management of patients, reduces the incidence of complications, and protects the safety of mothers and children.

 

2019 American College of Obstetricians and Gynecologists(American College of Obstetricians and Gynecologists,ACOG)Released the "Guidelines for Hypertension and Preeclampsia in Pregnancy 2019"。

 

 

Interpretation of ACOG Guidelines on High Risk Factors of Hypertension in Pregnancy:

 

 

Compared with the 2013 version of the guidelines, the guidelines added pre-pregnancy BMI> 30, antiphospholipid antibody syndrome and obstructive sleep apnea, adjusted the advanced age from> 40 years old to ≥ 35 years old, and removed the family history of preeclampsia. The above high-risk factors are further divided into high-risk and intermediate-risk factors, which provide medication indications for the use of aspirin to prevent hypertension in pregnancy. At the same time, the guidelines point out that recent studies suggest that genetic factors play a role in the occurrence of hypertension in pregnancy.

 

Interpretation of the ACOG guidelines on the diagnostic criteria for preeclampsia:

 

 

The 2019 version of the guidelines emphasizes the need to pay attention to clinical symptoms, and also proposes to be cautious about clinical symptoms, especially headache as a diagnosis of severe manifestations is often non-specific, so in the case of only headache symptoms but lack of other evidence, eclampsia Preliminary diagnosis requires caution.

 

Secondly, the guidelines also suggest that when there are clinical manifestations similar to preeclampsia 20 weeks ago, it is necessary to be alert to thrombotic thrombocytopenic purpura, hemolytic uremic, trophoblastic disease, kidney disease, and autoimmune disease. In addition, urine protein is still used as an important but not necessary diagnostic basis.

 

Interpretation of ACOG Guidelines for Fetal Outcomes:

 

 

Due to abnormal placental implantation in early pregnancy and subsequent uterine artery recasting disorder, it will cause abnormal uterine placental blood flow and insufficient blood supply to the fetal placental unit. Other mechanisms of chronic uteroplacental ischemia include placental vascular injury. And this uteroplacental ischemia can lead to fetal growth restriction, oligohydramnios, placental abruption, and unsatisfactory prenatal fetal state. Therefore, the fetus of patients with preeclampsia is often at risk of spontaneous or therapeutic preterm birth.

 

  Early markers of preeclampsia  

 

The early prediction of preeclampsia is of great significance to the early detection and early treatment of the disease, and can significantly improve the maternal and infant outcome. Among them, serological markers have the characteristics of easy access and measurement, and have good clinical application value.

 

 

Take the single factor predictor PIGF as a representative:

 

 

PlGF is a member of the VEGF family. The main role of PlGF is to promote the development and maturation of the placental vascular system and villi.

 

Research by Ukah et al. showed that compared with normal pregnant women, the expression of PlGF in the plasma of patients with preeclampsia was low. The level of PlGF in the peripheral blood of patients with preeclampsia is lower than that of normal pregnant women, and the more severe the disease, the lower the level of PlGF. At the same time, the level of PlGF in the maternal serum can be detected in the first 5 weeks after the appearance of clinical symptoms of preeclampsia after 13-16 weeks of pregnancy. The level of PlGF is believed to be useful for predicting the development of preeclampsia.

 

Studies by Tsiakkas and others have shown that when using PlGF to predict preeclampsia, the detection rates of preeclampsia that occur at <32 weeks of pregnancy are 79% and 97% at 12 and 22 weeks of pregnancy, respectively. ~36+6 weeks of preeclampsia, the detection rates at 12 weeks, 22 weeks, and 32 weeks of gestation were 57%, 65%, and 90%, respectively. The predictive effect of the onset of preeclampsia is better. At present, many indicators can be used to predict preeclampsia, and PlGF has been written into textbooks for clinical testing.

 

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Original source

1.Wang Qiong, Wang Yonghong. Research progress of early preeclampsia serological predictive markers[J]. International Journal of Obstetrics and Gynecology, Volume 46, Issue 4, August 2019

 

2.Yang Yike, Qi Hongbo. Interpretation of the main points of the American College of Obstetricians and Gynecologists (ACOG) "Guidelines for Hypertension and Preeclampsia in Pregnancy 2019" (Part 1) [J]. Chinese Journal of Practical Gynecology and Obstetrics, August 2019, Volume 35 Issue 8

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