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Abstract：
Preeclampsia is becoming an increasingly common diagnosis in the developed world and remains a high cause of maternal and fetal morbidity and mortality in the developing world. Delay in childbearing in the developed world feeds into the risk factors associated with preeclampsia, which include older maternal age, obesity, and/or vascular diseases. Inadequate prenatal care partially explains the persistent high prevalence in the developing world. In this review, we begin by presenting the most recent concepts in the pathogenesis of preeclampsia. Upstream triggers of the well described angiogenic pathways, such as the heme oxygenase and hydrogen sulfide pathways, as well as the roles of autoantibodies, misfolded proteins, nitric oxide, and oxidative stress will be described. We also detail updated definitions, classification schema, and treatment targets of hypertensive disorders of pregnancy put forth by obstetric and hypertensive societies throughout the world. The shift has been made to view preeclampsia as a systemic disease with widespread endothelial damage and the potential to affect future cardiovascular diseases rather than a self-limited occurrence. At the very least, we now know that preeclampsia does not end with delivery of the placenta. We conclude by summarizing the latest strategies for prevention and treatment of preeclampsia. A better understanding of this entity will help in the care of at-risk women before delivery and for decades after.
摘要：
先兆子痫在发达国家正成为越来越普遍的诊断,并且在发展中国家仍然是母体和胎儿发病率和死亡率的高原因。发达国家的生育延迟导致与先兆子痫相关的危险因素，其中包括年龄较大的产妇，肥胖，和/或血管疾病。产前护理不足部分解释了发展中国家持续的高患病率。在这次审查中,我们首先介绍了子痫前期发病机制的最新概念。良好描述的血管生成途径的上游触发因素，如血红素加氧酶和硫化氢途径，以及自身抗体的作用，错误折叠的蛋白质，一氧化氮,和氧化应激将被描述。我们还详细介绍了更新的定义，分类模式，以及全世界产科和高血压协会提出的妊娠期高血压疾病的治疗目标。已经做出转变以将先兆子痫视为全身性疾病,其具有广泛的内皮损伤并且有可能影响未来的心血管疾病而不是自我限制的发生。至少,我们现在知道先兆子痫不会随着胎盘的分娩而结束。最后，我们总结了子痫前期预防和治疗的最新策略。更好地了解这一实体将有助于在分娩前和分娩后的几十年里照顾有风险的妇女。
