2024-03-18 05:50:28
Preeclampsia does not necessarily cause fetal growth retardation. Here are the different types of preeclampsia.
Text/Interview and consultation by Li Aifen/Su Guoming, attending physician of the Obstetrics and Gynecology Department of the Tri-Service General Hospital
As medical diagnosis continues to advance, treatment methods can become more individualized and precise in order to truly solve patients’ problems. For preeclampsia, in addition to generally distinguishing the severity according to the number of weeks of pregnancy; an article published in the “American Journal of Obstetrics and Gynecology – Journal of Maternal-Fetal Medicine” in December 2023 proposed a new classification of preeclampsia: First Although there are still no major changes in treatment between Type 2 and Type 2, the subtle differences can better highlight the customized treatment provided for individual differences.
Preeclampsia is a common pregnancy complication. According to statistics from the Ministry of Health and Welfare, the incidence of preeclampsia in Taiwan is regarding 2 to 8%, and it is one of the top three causes of maternal death (another The two causes are amniotic fluid embolism and postpartum hemorrhage).
Preeclampsia does not necessarily cause fetal growth retardation. Here are the different types of preeclampsia.
Past classification methods
Regarding the classification of preeclampsia, in the past, the distinction was based on the time of occurrence. “34 weeks is used as the dividing line. Those that occur before 34 weeks are called “early-onset preeclampsia”, which is the most common cause of complications between pregnant women and fetuses. The earlier it occurs, the greater the impact on the fetus; if it occurs later than 34 weeks, it is called “late-onset preeclampsia”; if it occurs following delivery, it is called “late-onset preeclampsia”. The latter two have a greater impact on the mother’s health. Greater impact”.
In terms of disposal, the most direct method is to give birth (terminate pregnancy)! With the birth of the fetus, especially the delivery of the placenta, the clinical symptoms of preeclampsia will gradually disappear. Dr. Su Guoming pointed out, “The symptoms of most patients will be relieved, but a small number of patients will continue to have high blood pressure.” Therefore, doctors will choose the appropriate time to give birth based on clinical symptoms, but this will also lead to premature delivery of the fetus.
Current Diagnosis and Classification Methods
Dr. Su Guoming pointed out that the current definition of hypertension has changed. It is no longer the previous systolic blood pressure of 140mmHg and diastolic blood pressure of 90mmHg. “The hypertension treatment guidelines issued by the Taiwan Hypertension Society and the Taiwan Heart Association in 2022 will set the standards for hypertension.” It was revised down to 130 mmHg for systolic blood pressure and 80 mmHg for diastolic blood pressure.”
The original way of distinguishing according to the time of occurrence is also different. “The American Journal of Obstetrics and Gynecology-Maternal-Fetal Medicine (AJOG-MFM), a sister publication of the American College of Obstetrics and Gynecology, proposed a new concept in December 2023, dividing eclampsia into Presymptoms are divided into two types: TYPE 1 is placental malfunction, and TYPE 2 is maternal cardiovascular maladaptation to pregnancy.” Dr. Su Guoming explains as follows:
Preeclampsia does not necessarily cause fetal growth retardation. Here are the different types of preeclampsia.
Type I: placental dysfunction
Most often occur before 34 weeks. To put it simply, “poor placental condition leads to poor communication between the fetus and the placenta.” Due to problems with the blood vessels connecting the uterus and the placenta, sufficient blood flow cannot be smoothly supplied to the fetus, causing the fetus to suffer from growth retardation and respiratory distress. Condition.
Type II: maternal cardiovascular maladaptation
Most occur following 34 weeks. Preeclampsia often accompanies pregnancy with twins, multiples, or excessive fetal size due to gestational diabetes, resulting in maternal maladaptation. In addition, pregnant women who are obese have a greater burden on their cardiopulmonary function and are more likely to develop preeclampsia later in pregnancy.
He added, “Not all preeclampsia will cause fetal growth retardation. For example, in pregnant women with gestational diabetes, it is not that the placenta does not function well, but that the blood vessels function poorly. This also explains why the patient’s placenta grows. The factor (PIGF) value is good, but there is a cause of symptoms.”
treatment
In terms of treatment, both types of preeclampsia will use antihypertensive drugs to control blood pressure below 130mmHg systolic blood pressure and 80mmHg diastolic blood pressure to avoid complications such as severe preeclampsia, eclampsia or placental dissection in pregnant women. . The difference is:
Type 1: Placental dysfunction
In addition to blood pressure lowering drugs, it is also recommended to take low-dose aspirin from early pregnancy, and also supplement vitamin D and calcium. Pregnant women with severe preeclampsia and eclampsia should use anti-epileptic drugs according to their situation to prevent epilepsy.
Type 2: maternal cardiovascular maladaptation
In addition to medications, you need to exercise, actively manage your weight, and reduce sugar intake to reduce the burden on your cardiopulmonary function.
In the case of severe preeclampsia, “the past practice was to try to prevent the fetus until the baby is born, but now the tendency is to consider letting the fetus come out first (that is, terminating the pregnancy) if the pregnancy is 34 weeks or 32 weeks to reduce the risk to the mother and fetus.” the extent of the damage.”
※The original article was published in the March 2024 issue of “Mother and Baby” No. 445.
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