Prevention And Effective Evaluation For Hypertensive Diseases In Pregnancy

Hypertensive disorder in pregnancy is the special disease during pregnancy and is a leading cause resulting in the maternal and fetal death. There was no effective prevention and treatment measures with hypertensive disease in pregnancy because of the unclear nosogenesis and mechanism. The treatments for it were mainly to aim at the symptoms and to terminate pregnancy, which often resulted in the therapeutic inefficiency for some severe patients, leading to the increase of maternal and fetal death risk. The incidence rate of hypertensive disease in pregnancy was about 9.4% in our country. The epidemic investigation of pregnant women and parturient in Zhongmu area from January, 2000 to December, 2004 indicated the incidence rate of hypertensive disease in pregnancy were 10.36%, which was the obstetrical common disease and the secondary cause of maternal death, and also one of the main reason of fetal death, severely threatening the health of mother and infant. This research investigated the risk factors of hypertension in pregnancy firstly, then administrating comprehensive interventions aiming directly at the risk factors. This intervention models found in this research will be helpful for controlling the incidence of hypertensive disorder in pregnancy, especially for decreasing the incidence of severe preeclampsia and eclampsia and enhancing the health levels of mothers and infants.Investigation Objects and Methods: The database of 13444 inpatient-delivering women in Maternal and Child Health Hospital of Zhongmu Country ,Henan province from January, 2000 to December, 2004 was investigated retrospectively. The related factors involving hypertensive disease in pregnancy were analyzed, finding out the high risk factors through investigation, then formulating the prevention measures according to the high risk factors. The 2623 pregnant women from 3 towns of 19 towns of Zhongmu County were chosen randomly as experimental group from January, 2005 to December, 2006, the 3052 inpatient-delivering women from non-sample town at the same period as control group. The objects from experimental group received comprehensive intervention. (1) Open and participating management. The objective, content and method of research were explained to the pregnant women and their families so that they can cooperate with the program team actively. The doctors and patients can communicate with each other in time through establishing communication connections, so that the objects could accept mental intervention. (2) Establishing card at the early part of pregnancy. The pregnant women whose gestational ages have achieved 20w were screened. The high-risk group, e.g. "age<18 or = 35", "BMI = 25", "multifetation" , " history or familly history of hypertension in pregnancy" , "anaemia", "malnutrition", "mental stress" and "hypertension trend" etc. was monitorred intensively and managed specially. Some measures were taken for them, e.g. "health care of gravid and circumnatal period", "reasonable diet", "health education", "persistent left-lateral position", "calcium preparation and small dose aspirin administeration", " the severe case and the complication hospitalization", to interfere with directly. The control group only received routine intervention.Results:(1) The average incidence rate of hypertension in pregnancy was 10.36% from January, 2000 to December, 2004 in Zhongmu area. The incidence rate in rural area was 11.18%, which was higher significantly than that in urban area (6.36 %),χ~2=11.12, P<0.01.(2) The incidence rate of hypertension in pregnancy was higher in the pregnant women whose ages were < 18 or =35 than that in other age groups (χ~2 =69.94, P<0.01). "BMI = 25 (χ~2 =83.81, P<0.01)" , "mental stress(χ~2 =44.37, P < 0.01)" , "history or family history of hypertension in pregnancy (χ~2 =48.76, P<0.01)" , "anaemia (χ~2 =17.22, P<0.01)","multifetation (χ~2 =36.76, P<0.01)" were higher in the pregnant women withhypertensive disease.(3) The incidence rate of pregnancies complicated by gestational hypertension, and severe preeclampsia, eclampsia in the experimental group was 6.79%, 1.49%, 9.21% respectively and 3.80% in the control group, Z=4.15, P< 0.001.(4) The incidence of uterine-incision delivery and postpartum hemorrhage in the experimental group was 55.06%, 3.93%, respectively, and 66.19%, 9.25% inthe control group. The difference was significant,χ~2=5.73, P<0.05. The incidence rate of low birth weight was 6.74% in the experimental group and 13.52% in the control group, the difference was significant,χ~2 =5.16, P<0.05.Conclusions:(1) The incidence rate of hypertension in pregnancy was higher in rurul area than in urban area. The pregnant women with younger than 18 or older than 35, fatness, mental stress, multiple pregnancy, history or family history of hypertension in pregnancy and malnutrition are more likely to develop hypertension.(2) The participating consciousness of the patients can be elevated through the opening and participating management. The doctor-patient relationship can be intimated through one-to-one exchange.(3) The incidence rate of hypertension in pregnancy can be decreased through the scientific effective prevention measures.