32 40歲的真真目前懷孕30週，是第一胎，過去無重大疾病之病史，產檢也都正常。此次產檢時血壓為150/95 mmHg，尿蛋白2＋，她抱怨這幾天來常頭痛、右上腹不舒服及偶爾視力模糊，兩三天來自覺胎動減少，胎兒超音波預估體重約1000克重，她很擔心目前寶寶的情形。如果您是她產檢的醫師，下列敘述何者錯誤？

 真真目前的情況已經符合子癎前症（preeclampsia）的定義

肝臟Glisson capsule受到壓力拉扯造成真真的右上腹痛，是一般孕期常見的現象

真真的腎臟血流（renal plasma flow）及腎絲球過濾率（GFR）均較同週數之正常孕婦為低

年紀較大或頭胎懷孕（nulliparous）是好發子癎前症的危險因

ANS B

Pre-eclampsia is diagnosed when a pregnant woman develops

high blood pressure (two separate readings taken at least 6 hours apart of 140/90 or more) and

300 mg of protein in a 24-hour urine sample (proteinuria).

A rise in baseline blood pressure (BP) of 30mmHg systolic or 15mmHg diastolic, while not meeting the absolute criteria of 140/90, is still considered important to note, but is not considered diagnostic.

Swelling or edema (especially in the hands and face) was originally considered an important sign for a diagnosis of pre-eclampsia, but in current medical practice only hypertension ^[2] and

proteinuria are necessary for a diagnosis.

Pitting edema (unusual swelling, particularly of the hands, feet, or face, notable by leaving an indentation when pressed on) can be significant, and should be reported to a health care provider.

Diagnostic criteria for severe preeclampsia include at least one of the following:

• Systolic BP greater than 160 mm Hg or diastolic BP greater than 110 mm Hg on 2 occasions 6 hours apart with the patient at bed rest
• Proteinuria greater than 5000 mg in a 24-hour collection or more than 3+ on 2 random urine samples collected at least 4 hours apart
• Oliguria with less than 500 mL per 24 hours
• Persistent maternal headache or visual disturbance
• Pulmonary edema or cyanosis
• Concerning abdominal pain
• Impaired liver function test findings
• Thrombocytopenia
• Oligohydramnios, decreased fetal growth, or placental abruption

Eclampsia is defined as seizures in a patient with preeclampsia.

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33 承上題，真真接受了全血球計數及一般生化檢查，白血球11.2 K/μL，血小板67 K/μL，血紅素10.3 g/dL，AST 160 U/L，ALT 180 U/L，LDH 950 U/L；休息後重測一次血壓為160/110 mmHg，且頭痛欲裂，進一步超音波臍帶動脈都卜勒檢查發現如下。下列敘述何者錯誤？

真真的情形符合HELLP症候群

真真的胎兒有嚴重胎內成長遲滯的情形（fetal growth restriction）

真真的血液中soluble Fms-like tyrosine kinase 1（sFlt1）及placental growth factor（PLGF）的數量與生物可利用性（bioavailability）皆較一般孕婦為高

真真的情形已符合嚴重子癎前症（severe preeclampsia），需要立刻進一步處置

ANS C

c is definitely wrong. there is no way to arrive such diagnosis. no data avaialable.

HELLP syndrome: A syndrome featuring a combination of "

H" for hemolysis (breakage of red blood cells),

"EL" for elevated liver enzymes, and

"LP" for low platelet count (an essential blood clotting element).