What Is the Pathophysiology of Preeclampsia?

Eclampsia, TCM disease name. Sudden vertigo occurs during the third trimester of pregnancy, before or after childbirth, fainting, unknown, upper eye, closed teeth, convulsions of the limbs, rigidity of the whole body, awakening, recurrence, or even unconsciousness. "Epilepsy", also known as "children", "pregnancy epilepsy syndrome." According to the time of onset, if it occurs in late pregnancy or before delivery, it is called prenatal eclampsia; if it occurs after a new birth, it is called "postpartum eclampsia". Prenatal eclampsia is more common clinically. Eclampsia is critical, acute, and severe in obstetrics, and it seriously threatens the safety of mothers and infants.

Explanation of eclampsia terms

Eclampsia refers to pregnant women who have dizziness and headaches during the third trimester of pregnancy or when they are in labor or after a new birth. They suddenly faint and go unconscious. Both eyes look up and their hands and feet twitch. Called "eclampsia", also known as "pregnancy syndrome." Preeclampsia in pregnancy develops from aggravation of symptoms and signs of preeclampsia. Eclampsia can occur during pregnancy, childbirth, or within 24 hours after childbirth. It is called prenatal eclampsia, postpartum pain, and postpartum eclampsia, respectively. It is one of the four major causes of death in obstetrics. Once it occurs, maternal and child complications and mortality significantly increase, so special attention should be paid to emergency treatment. Once pregnant women have eclampsia, they are more likely to be ferocious and have a very high mortality rate.

History of eclampsia

1. Ancient books have recorded similar diseases long ago, "Earth Diseases and Presence of Pregnancy Vibration and Spasm" put forward "... those who are pregnant and suffocate but don't know anyone. They must wake up, wake up and relapse, it is also the work of the wind and the sun. Spasm too. "

2. Regarding the pathogenesis of this disease, Liu Wansu believes that "the kidney water is weak and the heart is warm, and the liver is not supported."

3. "Wanshi Gynecology" states that "eclampsia is also caused by Qi deficiency, phlegm and fire."

4. "Shen's Female Science Series, Pregnancy-like Wind" summarizes the cause of the disease: "One is Yin deficiency, the second is Qi stagnation, and the third is Phlegm." In summary, the occurrence of eclampsia is mainly The deficiency of yin deficiency is based on wind, fire and sputum.

Relationship between eclampsia and western medicine diseases

This disease is a "pregnancy-induced hypertension disease" in Western medicine. Hypertension, preeclampsia, and eclampsia, which were collectively referred to as pregnancy hypertension syndrome in the past, are one of the important causes of maternal and perinatal death .

Pregnancy-induced hypertension syndrome, referred to as "pregnancy-induced hypertension," is a pregnancy-specific hypertension that occurs after 24 weeks of pregnancy, with symptoms such as hypertension, edema, and proteinuria. The cause of pregnancy-induced hypertension syndrome is not really clear. So far, there are more generally recognized immunological theories, uterine placental ischemia, renin-angiotensin-prostaglandin system imbalance and diffuse intravascular coagulation are closely related to their pathogenesis. . The basic physiological change of pregnancy induced hypertension is systemic arteriolar spasm which leads to pathophysiological changes of brain, kidney, heart, liver, and uterine placenta to varying degrees, resulting in corresponding clinical manifestations. With the different severity of pregnancy induced hypertension, its coagulation function also changes accordingly, which can even lead to diffuse intravascular coagulation (DIC).

Causes of eclampsia

The main cause of the disease is liver movement and phlegm disturbance. If the maternal body is inadequate liver and kidney, or the spleen and stomach are weak, due to pregnancy loss, anger hurts the liver, liver stagnation and fire, the wind is moving the wind, the wind assists the fire, the fire and the fire incite; Blazing and blinding. Late pregnancy, labor or postpartum, yin blood gathers or yin blood is depleted, yang loses potential, Wuzhihuahuo, qi and blood rebellion, tendons and veins are deprived, gods are not inward, and tendon veins spasm, limbs pumping Pain, coma, etc. So many dirty parts are involved, cause and effect are wanted, the condition is complicated, and life-threatening.

Eclampsia

Intrahepatic wind movement

The corpus yin deficiency, yin and blood raising after pregnancy, kidney essence loss, heart and liver insufficiency, liver yang hyperactivity, weathering and fire, fire and fire inciting, then eclampsia.

2. Disturbance on sputum

Elemental yin deficiency, yin deficiency and internal heat, burning sputum as sputum, phlegm fever and redness, or elementary spleen deficiency or liver spleen spleen, spleen deficiency and dampness gathering, stagnation and heat, phlegm and heat, spleen and heat, spleen and spleen Seizures, eclampsia.

Essentials of eclampsia diagnosis

Basis of diagnosis of eclampsia

(A) medical history

Pre-pregnancy may or may not have a history of hypertension, kidney disease, diabetes, family history of hypertension; twins, multiple pregnancies, polyhydramnios, history of hydatidiform mole; history of eclampsia.

(Two) clinical manifestations

In late pregnancy, or at the time of childbirth, or after childbirth, suddenly feel dizzy and faint, unaware, eyes closed, teeth closed, limbs twitched, angled bow reversed, must be awake, relapse, or even coma . Or on the basis of preeclampsia, the symptoms of convulsions and coma are eclampsia.

Differential diagnosis of eclampsia

It is mainly distinguished from seizures associated with pregnancy: epilepsy has a similar history of seizures. Before the onset, there were generally no headaches, dizziness, dazzling or chest tightness, nor were there any symptoms and signs such as hypertension, edema, and urinary protein.

Eclampsia- related tests

Before or after 20 weeks of pregnancy, there may or may not be a history of hypertension. After 20 weeks of pregnancy, blood pressure rises to 18.7 / 12.0kpa (140 / 90mmHg), or 4.0kpa (30 / 15mmHg) higher than the basic blood pressure, with urine protein Edema can be diagnosed as preeclampsia.

Blood test: increased hematocrit, abnormal blood viscosity, abnormal whole blood viscosity, and hypercoagulable state.

Liver and kidney function tests: uric acid, urea nitrogen, creatinine, alanine aminotransferase abnormalities. The binding force of carbon dioxide was measured to determine the presence or absence of acidosis.

Fundus examination: severe retinal arteriolar spasm. Systemic arteriolar spasm is the basic lesion of preeclampsia.

Dialectical treatment of eclampsia

Dialectical points of eclampsia

The prevention and treatment of eclampsia should be more important than the treatment, because the progress of the disease has obvious stages, so the treatment of traditional Chinese medicine focuses on preeclampsia and preeclampsia.

Principles of eclampsia treatment

Pre-eclampsia is to prevent eclampsia by nourishing yin and nourishing blood, and smoothing liver and burying sun. Once eclampsia occurs, full attention should be paid to the degree and frequency of coma and convulsions, and the treatment is mainly to clear the liver and quench wind and calm the nerves.

Category of eclampsia

(1) Liver Wind Internal Motion Card

Main syndromes: headache, dizziness, sudden limb twitching, unconsciousness, closed teeth, angled bows, seasonal flushing, facial flushing, dry mouth, and dry mouth. The tongue is red or creeping, the moss is absent or flower peeled, and the pulse strings are thin and counted.

Governing Law: Ziyin Qianyang, Pinggan Xifeng.

Representative party: Antelope hook rattan soup or stop smoking.

Recipe: Antelope horn, Uncaria vine, mulberry leaf, chrysanthemum, Fritillaria, Zhu Ru, raw huang huang, Bai Zhi, Zhi Shen, licorice.

(2) Disturbance on phlegm

Main symptoms: late pregnancy, during labor or after new labor, dizziness, severe chest distress, panic, sudden collapse, unconsciousness, whole body convulsions, rough sputum, red tongue, yellow greasy fur, slippery pulse strings

Governing Law: clearing heat and resuscitation, expelling phlegm and quenching wind.

Representative party: Niuhuang Qingxin Pill ("Zhu Shi Shi He Xin Fa") plus Zhuli or Angong Niuhuang Pill.

Recipes: bezoar, cinnabar, coptis, scutellaria baicalensis, mandarin duck, turmeric. ^[1]

Emergency treatment for eclampsia

Once eclampsia is diagnosed, she is immediately hospitalized and actively treated. Treatment principles are antispasmodic, antihypertensive, sedative, reasonable volume expansion, diuretic if necessary, and timely termination of pregnancy. Chinese and Western medicine cooperate with rescue.

Outcome of eclampsia

Swelling, halo (preeclampsia), and eclampsia can be considered as different stages of the same disease. The first is subswelling and halo, which is an effective period of Chinese medicine treatment. If the treatment is not timely at this time, the condition will develop further. Pre-eclampsia can occur, with slight carelessness, and as soon as it is triggered. Once eclampsia occurs, rescue with integrated Chinese and Western medicine is needed. If treatment is timely and handled properly, convulsions can be controlled, and the mother and child may be safe. If convulsions occur repeatedly and the convulsions take a long time, the prognosis is often poor and endangers the life of the mother and child.

Prevention of eclampsia

1. Early diagnosis and treatment are of great significance to control the development of disease, and prevention is more important than treatment.

2. Pay attention to rest, lying on the left side.

3. The diet should be high in protein and high in vitamins, and salt is generally not strictly controlled.

4. If it develops into eclampsia, nursing is more important. It should be in a single room, avoid sound and light stimulation, and add guards around the bed to prevent patients from falling.

5. Do not eat or drink during coma.

Literature related to eclampsia

1. "Symptoms of Pregnancy, Pregnancy and Spasm": Physical weakness and wind, and injury to the sun, stagnation of meridians, and later encounters cold and damp struggling, hair is dysentery, and the name is spasm. Those who are pregnant and don't recognize the stuffiness and coldness must wake up and wake up and relapse. It is also a wind injury and the sun can be used for spasm, also known as eclampsia, also known as childbirth. ^[2]

2. "Medical Psychology": Its symptoms are the most violent and urgent ... If it occurs frequently, if the fetal pregnancy is abrupt, you will see Qi and blood dissipate with the fetus, and the mother's life will be difficult to preserve. ^[3]

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