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Pre-eclampsia or preeclampsia (PE) is a disorder of pregnancy characterized by high blood pressure and a large amount of protein in the urine.[1] The disorder usually occurs in the third trimester of pregnancy and gets worse over time.[2][3] In severe disease there may be red blood cell breakdown, a low blood platelet count, impaired liver function, kidney dysfunction, swelling, shortness of breath due to fluid in the lungs, or visual disturbances.[2][3]PE increases the risk of poor outcomes for both the mother and the baby.[3] If left untreated, it may result in seizures at which point it is known as eclampsia.[2]
’’’子癲前症’’’（{{lang-en|pre-eclampsia, preeclampsia}}，簡稱{{lang|en|PE}}）為[[妊娠|懷孕]]期間發生的疾病，其特徵為[[高血壓]]與[[蛋白尿]][1]。該疾病通常發生於第三孕期，越到後期越嚴重[2,3]。病情嚴重時可能會發生[[溶血反應]]、{{link-en|血小板過低|Thrombocytopenia}}、肝或腎功能損傷、[[水腫]]、{{link-en|肺水腫|Pulmonary edema}}或視力障礙[2,3]。該疾病會提升母子兩者不良預後的風險[3]。如果不及時治療，將可能導致{{link-en|癲癇發作|Epileptic seizure}}，也就是[[子癲]][2]。
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Risk factors for PE include: obesity, priorhypertension, older age, and diabetes mellitus.[2][4] It is also more frequent in a women’s first pregnancy and if she is carrying twins.[2] The underlying mechanism involves abnormal formation of blood vessels in the placentaamongst other factors.[2] Most cases are diagnosed before delivery. Rarely, preeclampsia may begin in the period after delivery.[3] While historically both high blood pressure and protein in the urine were required to make the diagnosis, some definitions also include those with hypertension and any associated organ dysfunction.[3][5] Blood pressure is defined as high when it is greater than 140 mmHg systolic or 90 mmHg diastolic at two separate times, more than four hours apart in a women after twenty weeks of pregnancy.[3] PE is routinely screened for during prenatal care.[6]
子癲前症的風險因子包含：[[肥胖症]]、懷孕之前罹患[[高血壓]]、高年齡與[[糖尿病]][2,4]。女性初次懷孕，尤其是懷有雙胞胎，為子癲前症的高風險族群[2]。該疾病的底層機制涉及了[[胎座|胎座的血管形成]]異常以及其他因素[2]。大多數病例都是在分娩前確診，只有極少數病例是在[[產後護理]]期間發作[3]。擁有高血壓與蛋白尿的病史，是此疾病確診的重要因素，但高血壓、任何與此症相關的器官功能障礙等其他因素，也應一併考量在內[3,5]。如果婦女在懷孕20週以後，連續4小時的收縮壓高於140毫米汞柱，舒張壓高於90毫米汞柱，則必須注意是否為子癲前症的徵兆[3]。該疾病可由定期的{{link-en|產前護理|Prenatal care}}檢查中發現[6]。
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Recommendations for prevention include: aspirin in those at high risk, calcium supplementation in areas with low intake, and treatment of prior hypertension with medications.[4][7] In those with PE delivery of the fetus and placenta is an effective treatment.[4] When delivery becomes recommended depends on how severe the PE and how far along in pregnancy a person is.[4] Blood pressure medication, such as labetalol andmethyldopa, may be used to improve the mother’s condition before delivery.[8] Magnesium sulfate may be used to prevent eclampsia in those with severe disease.[4] Bedrest and salt intake have not been found to be useful for either treatment or prevention.[3][4]
此症的推薦預防方法包含：在高風險因子發生時服用[[阿斯匹靈]]、在鈣質攝食缺乏的地區加強[[鈣|補充鈣質]]以及懷孕前採用藥物治療高血壓[4,7]。如果發生子癲前症，將胎兒與胎盤分娩是一種有效的治療方法[4]，採取此措施必須考量子癲前症的嚴重程度以及孕期長度[4]。[[拉貝洛爾]]、{{link-en|甲基多巴|Methyldopa}}等[[抗高血壓藥]]能夠改善母親在分娩之前的症狀[8]。[[硫酸鎂]]可用於預防子癲等嚴重疾病[4]。臥床休息與食鹽攝取對於治療與預防該疾病效益不大[3,4]。
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Preeclampsia affects between 2–8% of pregnancies worldwide.[4] Hypertensive disorders of pregnancy are one of the most common causes of death due to pregnancy.[8] They resulted in 29,000 deaths in 2013 – down from 37,000 deaths in 1990.[9] Preeclampsia usually occurs after 32 weeks; however, if it occurs earlier it is associated with worse outcomes.[8] Women who have had PE are at increased risk of heart disease later in life.[6]The word eclampsia is from the Greek term for lightning.[10] The first known description of the condition was by Hippocrates in the 5th century BCE.[10]
<流行病學與預後>
子癲前症影響全球約2-8%的孕婦<ref name=WHO2011>{{cite book|title=WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia.|year=2011|isbn=978-92-4-154833-5|url=http://whqlibdoc.who.int/publications/2011/9789241548335_eng.pdf}}</ref>，尤其{{link-en|妊娠高血壓|Hypertensive disease of pregnancy}}是懷孕期間最常見的死亡原因<ref name=Aru2013>{{cite journal|last=Arulkumaran|first=N.|author2=Lightstone, L.|title=Severe pre-eclampsia and hypertensive crises|journal=Best Practice & Research Clinical Obstetrics & Gynaecology|date=December 2013|volume=27|issue=6|pages=877–884|doi=10.1016/j.bpobgyn.2013.07.003}}</ref>。1990年，妊娠高血壓導致了3.7萬人死亡；直到2013年仍然造成2.9萬人死亡<ref>{{cite journal|last1=GBD 2013 Mortality and Causes of Death|first1=Collaborators|title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.|journal=Lancet|date=17 December 2014|pmid=25530442|doi=10.1016/S0140-6736(14)61682-2}}</ref>。子癲前症通常發生在懷孕後32周，如果越早發生，相對的後果也會較為嚴重<ref name=Aru2013/>。懷孕期間出現子癲前症的女性，之後發生[[心血管疾病]]的危險性也會偏高<ref name=Lancet2010>{{cite journal|last=Steegers|first=Eric AP|coauthors=von Dadelszen, Peter; Duvekot, Johannes J; Pijnenborg, Robert|title=Pre-eclampsia|journal=The Lancet|date=August 2010|volume=376|issue=9741|pages=631–644|doi=10.1016/S0140-6736(10)60279-6|pmid=20598363}}</ref>。eclampsia 這個字來自於希臘文中「照亮」的意思<ref name=Em2006/>。西元前5世紀，[[希波克拉底]]被認為是第一位描述子癲前症的醫師<ref name=Em2006>{{cite book|author1=Emile R. Mohler|title=Advanced Therapy in Hypertension and Vascular Disease|date=2006|publisher=PMPH-USA|isbn=9781550093186|pages=407–408|url=https://books.google.ca/books?id=sCgURxhCJ-8C&pg=PA407}}</ref>。