Hypertensive disorders in pregnancy are common obstetric disorders, accounting for 5% to 10% of all pregnancies, and the resulting maternal deaths account for about 10% to 16% of all pregnancy-related deaths, making it the second leading cause of maternal mortality. Its main symptoms include hypertension, proteinuria, and edema. The aim of treatment of hypertensive disorders in pregnancy is to prevent the occurrence of severe preeclampsia and eclampsia, to reduce the rate of perinatal morbidity and mortality of mother and fetus, and to improve the prognosis of mother and child. The etiology of the disease may involve a variety of maternal, placental and fetal factors, including abnormal trophoblast invasion, abnormal immune regulatory function, endothelial cell damage, genetic factors and nutritional factors. However, no single factor can explain the etiology and mechanism of all preeclampsia. 1. Abnormal trophoblast invasion may be an important factor in the development of preeclampsia. In patients with incomplete trophoblast invasion of small spiral arteries, the small spiral arteries of the myometrium have not been recast, and the abnormally narrowed spiral arteries make the placenta have reduced perfusion and hypoxia, which ultimately leads to the occurrence of preeclampsia. 2.Abnormal immunoregulatory function The absence or dysregulation of maternal immune tolerance to placental and fetal antigens of paternal origin is an important part of the etiology of preeclampsia. Oxidative stress, anti-angiogenic and metabolic factors, and other inflammatory mediators can lead to vascular endothelial injury and trigger preeclampsia. Genetic factors Pre-eclampsia is a multifactorial and polygenic disease with family genetic predisposition: the incidence of pre-eclampsia in daughters of mothers suffering from pre-eclampsia ranges from 20% to 40%; the incidence of pre-eclampsia in women with pre-eclampsia in sisters ranges from 11% to 37%; and the incidence of pre-eclampsia in twins suffering from pre-eclampsia in sisters ranges from 22% to 47%. However, the pattern of inheritance is still unclear. Nutritional factors: Vitamin C deficiency may increase the risk of preeclampsia-eclampsia. Clinical manifestations 1.Prevalent groups Maternal age ≥40 years, history of preeclampsia, positive antiphospholipid antibodies, history of hypertension, history of renal disease, history of diabetes mellitus, at the time of the first obstetric examination, a family history of preeclampsia (mother or sister), multiple pregnancies, the current pregnancy is the first pregnancy, the interval between pregnancies is ≥10 years, and the systolic or diastolic blood pressure in the early stages of pregnancy is ≥80 mm Hg. Other groups susceptible to hypertensive disorders of pregnancy are: thrombophiliacs, thrombophiliacs, and other groups with a tendency to develop hypertensive disorders of pregnancy. The other groups of people are: prone to thrombosis, pre-pregnancy elevated blood triglycerides, low socio-economic status, family history of cardiovascular disease, drug abuse (cocaine/methamphetamine), pregnancy interval 7, 4L/min, pregnant women’s blood uric acid is elevated, and so on. 2, Symptoms (1) Hypertension elevated blood pressure ≥ 140/90 mmHg is the clinical manifestation of hypertensive disorders in pregnancy is characterized. When the blood pressure rises slowly, the patient has no conscious symptoms, but finds out that the blood pressure increases during physical examination, or feels dizziness and headache after nervousness, emotional excitement and exertion; when the blood pressure rises sharply, the patient may have severe headache, blurred vision, palpitation and shortness of breath, which may cause cardiovascular and cerebrovascular accidents. Patients with severe preeclampsia continue to have elevated blood pressure and develop severe hypertension ≥160/110 mmHg. (2) Proteinuria Urinary protein may change with vasospasm on a daily basis. In patients with severe preeclampsia, urinary protein continues to increase, and a large amount of proteinuria occurs, with urinary protein qualitatively ≥(++), or 24-hour urinary protein quantitatively ≥2g. (3) Edema may manifest as overt edema and occult edema. Visible edema mostly occurs in the ankle and lower limbs, and can also manifest as generalized edema. It is characterized by not disappearing after resting, or appearing suddenly, rapidly spreading to the whole body and even appearing plasma cavity effusion including abdominal cavity, thoracic cavity and pericardial cavity. Hidden edema refers to fluid retention in the interstitial space of tissues, and the main manifestation is abnormal weight gain. 3, Diagnosis At present, there are clear and widely accepted standards for the classification and diagnosis of hypertensive disorders in pregnancy at home and abroad. According to the basis of pathogenesis and the degree of organ damage, hypertensive disorders in pregnancy are classified into five categories, i.e. gestational hypertension, preeclampsia, eclampsia, chronic hypertension with preeclampsia and chronic hypertension. 1.Hypertension in pregnancy Hypertension in pregnancy for the first time, systolic blood pressure ≥140mmHg and/or diastolic blood pressure ≥90mmHg, returning to normal within 12 weeks after delivery. Negative urine protein. The diagnosis is not confirmed until after delivery. A few patients may be accompanied by epigastric discomfort or thrombocytopenia. 2.Preeclampsia Severe: Patients with preeclampsia can be diagnosed with severe preeclampsia if any of the following adverse conditions are present: ① persistent elevation of blood pressure: systolic blood pressure ≥160mmHg and/or diastolic blood pressure ≥110mmHg; ② proteinuria ≥2,0g/24hours or random proteinuria ≥(+++); ③ serum creatinine ≥1,2mg/dL unless it is known to have been previously raised; ④ platelets <100 ×109/L; ⑤ microplatelets <100 ×109/L; ⑤ microcreatinine ≥1,2mg/dL unless it is known to be previously elevated; and ⑤ platelets <100 ×109/L. × 109/L; ⑤ Microangiopathic hemolysis - elevated LDH; ⑥ Elevated serum aminotransferase levels - ALT or AS; ⑦ Persistent headache or other cerebral or visual disturbances; ⑧ Persistent epigastric pain. Eclampsia Convulsions occurring in women with preeclampsia that cannot be explained by other causes. 4.Chronic hypertension in pregnancy BP ≥140/90 mmHg before pregnancy or hypertension diagnosed before 20 weeks of gestation not due to trophoblastic disease in pregnancy, or hypertension diagnosed after 20 weeks of gestation and persisting until after 12 weeks postpartum. 5.Chronic hypertension complicating preeclampsia The new onset of proteinuria ≥300 mg/24h in hypertensive women without proteinuria prior to 20 weeks of gestation, the onset of proteinuria or a sudden increase in blood pressure in pregnant women with hypertension and proteinuria prior to 20 weeks of gestation, or a platelet count of <100 × 109/L. 4.Treatment 1.Treatment aim The aim of the treatment of hypertensive disorders of pregnancy is to prevent the occurrence of severe preeclampsia and The purpose of treatment of hypertensive disorders in pregnancy is to prevent the occurrence of severe pre-eclampsia and eclampsia, reduce the perinatal morbidity and mortality of mother and fetus, and improve the prognosis of mother and baby. The basic principles of treatment are rest, sedation, antispasmodic, lowering blood pressure and diuresis when indicated, close monitoring of the mother and fetus, and timely termination of pregnancy. It should be classified according to the severity of the disease and individualized treatment. (1) gestational hypertension rest, sedation, monitoring the mother and fetus, appropriate antihypertensive treatment; (2) preeclampsia sedation, antispasmodic, indicated antihypertensive, diuretic, close monitoring of the mother and fetus, timely termination of pregnancy; (3) eclampsia control of convulsions, stabilization of the condition of the termination of pregnancy; (4) pregnancy combined with chronic hypertension to antihypertensive treatment is the main attention to the incidence of preeclampsia; (5) chronic hypertension complicated by eclampsia (5) Chronic hypertension complicated by pre-eclampsia should be treated with both chronic hypertension and pre-eclampsia. Evaluation and monitoring The condition of hypertensive disease in pregnancy is complicated and changing rapidly, the purpose of monitoring and evaluation is to understand the severity and progress of the condition and to provide timely and reasonable treatment. 3. Examination items (1) Basic examination to understand the conscious symptoms such as headache, chest tightness, blurred vision, epigastric pain, etc., and to check blood pressure, urine routine, weight, urine output, fetal heart, fetal movement, fetal heart monitoring. (2) Special examination for pregnant women includes fundus examination, coagulation function, heart, liver and kidney function. (3) Special examination of the fetus includes fetal development, ultrasound to monitor the intrauterine condition of the fetus and umbilical artery blood flow. 4.General treatment Rest should be emphasized and lateral lying position should be taken. Ensure adequate protein and calorie intake. Restriction of salt intake is not recommended. To ensure sufficient sleep, diazepam (Valium) 2,5-5mg can be taken orally before bedtime if necessary. 5, antihypertensive treatment Pregnant women with severe hypertension whose blood pressure is ≥160/110mmHg should be treated with antihypertensive treatment; patients with non-severe hypertension whose blood pressure is ≥140/90mmHg can be used for antihypertensive treatment. Blood pressure should decline steadily, and should not be less than 130/80mmHg to ensure uteroplacental blood flow perfusion. 6, magnesium sulfate prevention and treatment of eclampsia Magnesium sulfate is the first-line drugs for eclampsia treatment, and is also the preventive drug for preventing eclampsia seizures in severe preeclampsia. For non-severe pre-eclampsia patients can also consider the application of magnesium sulfate. Dilatation therapy Dilatation therapy may lead to serious complications such as pulmonary edema and cerebral edema. Therefore, unless there is serious fluid loss (e.g. vomiting, diarrhea, blood loss during delivery), volume expansion therapy is generally not recommended. 8.Application of sedative drugs can relieve the symptoms of maternal stress and anxiety, improve sleep, and prevent and control eclampsia. Termination of pregnancy is the only effective treatment for preeclampsia if the condition of mother and fetus does not improve after active treatment or if the condition continues to progress. The emergency treatment of eclampsia includes general emergency treatment, controlling convulsions, controlling blood pressure, preventing recurrence of eclampsia and terminating pregnancy at the appropriate time. It needs to be differentiated from other convulsive disorders (e.g. hysteria, epilepsy, craniocerebral lesions, etc.). At the same time, important organ functions such as heart, liver, kidney, central nervous system, coagulation function and water-electrolyte acid-base balance should be monitored.