妊娠高血压疾病.ppt

1、,主编：沈铿 马丁 副主编： 狄文 孔北华 李力 赵霞,妇产科学(第3版),普通高等教育“十二五”国家级规划教材 卫生部“十二五”规划教材 全国高等医药教材建设研究会 全国高等学校教材 供基础、临床、预防、口腔医学类专业用,妊娠高血压疾病 hypertension disorders complicating pregnancy,YING ZHANG Department of Obstetrics and Gynecology The first Affiliated Hospital Sun Yat-sen University,Pregnancy-Related Mortality Un

2、ited States (1998-2005),Preeclampsia (12.3%),Other medical conditions (13.2%),Embolism (18%) PE (10%) AFE (8%),Cardiomyopathy (11.5%),CVAcerebrovascular accident (6%),Anesthesia (1%),Unknown (2.1%),Hemorrhage (12.5%),Obstet Gynecol 2010,Cardiovascular disease (12.4%),Infection (11 %),Common: 5% 12%

3、of pregnancies Morbidity: fetus: 12% of preterm deliveries mother: stroke, CHF, renal injury Mortality: 12-13% of maternal mortality,Categories,Gestational Hypertension Preeclampsia and eclampsia Chronic Hypertension Preeclampsia superimposed on Chronic Hypertension,Classification,1. Chronic hyperte

4、nsion Gestational hypertension 3. Preeclampsia - without severe features - with severe features (severe preeclampsia) 4. Chronic hypertension with superimposed preeclampsia - without severe features - with severe features,Hypertension in Pregnancy ACOG Task Force (Nov 2013),Risk Factors,Immune mecha

5、nism (rejection phenomenon, insufficient blocking Ab) Injury of vascular endothelium-disruption of the equilibrium between vasoconstriction and vasodilatation, imbalance between PGI and TXA Compromised placenta profusion Genetic factor Dietary factors: nutrition deficiency Insulin resistance Increas

6、e CNS irritability,Etiology,Etiology,Vasospasm predominant finding Endothelialinjury Nitric oxide microthrombi development Prostanoid balance Lipid peroxide, free radicals and antioxidants Ischaemia,Pathophysiology,Pathophysiology,Neurologic effects Renal effects Hematologic effects Cardiovascular e

7、ffects Blood Impaired liver function (LFTs 2X normal) Oliguria or serum creatinine in the absence of renal disease ; Progressive renal insufficiency (serum creatinine 1.1 mg/dL or 2X Thrombocytopenia 100,000,DIC, jaundice ,LDH Pulmonary edema, heart failure FGR or oligohydramnios early onset preecla

8、mpsia (EOSP),Classification Clinical manifestations,Eclampsia,Meets the criteria of preeclampsia Presence of rigidity. Convulsions.somnolence be fast or slow Observe frequently & ready ahead,Diagnostic strategies,Step one：determine the disease History Blood pressure Proteinuria,Step two：severity Blo

9、od test, Urine analysis Liver function, Renal function coagulation function Retinal check: ECG, cerebral angiography, etc placenta function, fetal maturity,Differential Diagnosis,Preeclampsia- pregnancy complicated with chronic nephritis Eclampsia - epilepsy, encephalitis, brain tumor, anomalies and rupture of