高血压英文ppt精品课件hypertensive disorders in _2

HYPERTENSIVE DISORDERS IN PREGNANCY DR. SALWA NEYAZI ASSISSTANT PROF KSU/ CONSULTANT OBGYN PEDIATRIC & ADOLESCENT GYNECOLOGIST TYPES OF HYPERTENSIVE DISEASE IN PREGNANCY 1-Gestational hypertension 2-PET 3-Eclampsia 4-Chronic hypertension 5-PET superimposed on chronic hypertension 1-Gestational hypertension BP 140/90 mm Hg for the first time during pregnancy No proteinuria BP returns to N 1.2 mg/dl unless known to be previously elevated Platelets 35 Y Nulliparity Black race Hx of PET in a 1st degree female relative Hx of PET in prior pregnancy DM Chronic renal disease Ch HPT Multiple pregnancy twins 13 vs 6% Hydatidiform mole Nonimmune hydrops fetalis Obesity 4.3% BMI 600 U/L -T bilirubin 1.2 mg/dl -AST 70U/L -Plt 160 mmHg or diastolic 110 mmHg on two occasions at least 6 hrs apart Proteinuria 5 g/24 hrs Oliguria 30, obese, multipara, DM, renal disease, black race, family Hx Difficult to deffirentiate HPT with superimposed PET from HPT with renal disease both have proteinuria INVESTIGATIONS Chest x ray cardiomegaly ECG Lt vent hypertrophy serum creatinine, creatinine clearance & proteinuria 5-10% MATERNAL COMPLICATIONS Superimposed PET in 1/3 of Pt risk of abruptio placentae 0.4-10% DIC, acute tubular & cortical necrosis If renal function is well creatinine 1.5 mg/dl pregnancy does not change the coarse of renal disease If renal function is affected prior to pregnancy deterioration of renal function occur more rapid in pregnancy FETAL COMPLICATIONS Prematurity 25-30% IUGR 10-15% Stillbirth & fetal distress due to abruptio placentae or ch intrauterine asphyxia TREATMENT No benefit of treating mild CH HPT ( 140-179/90-109) in pregnancy should be monitered for worsening HPT or superimposed PET Pt with severe CH HPT should have their BP controlled before pregnancy & continue Rx in pregnancy Methyle Dopa Calcium channel blockers B blockers can be used but IUGR Labetalol Obstetric management Serial U/S for fetal growth. BPP, NST34wk Follow up every 2 wks till 30 then weekly Warn the mother about symptoms of superimposed PET Investigations Renal function test,uric a , calcium ,LFT, 24hrs urine for creatinine clearance & protein, CBC, Urinalysis, ECG.GTT Early U/S for dating of preg Not allowed to continue past 40wks