高血压英文ppt精品课件hypertensive disorders in pregnancy （2）

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1、HypertensiveDisordersinPregnancyรองศาสตราจารย์นายแพทย์อติวุทธกมุทมาศScopeTerminologyandclassificationRiskfactorsEtiologyPathophysiologyPredictionandpreventionManagementIncidence3.7%ofpregnancies16%ofpregnancy-relateddeathsEclampsia1in2000deliveriesClassificationbytheworkinggroupof

2、theNHBPEP(2000)1.Gestationalhypertension2.Preeclampsia3.Eclampsia4.Preeclampsiasuperimposedonchronichypertension(superimposedpreeclampsia)5.ChronichypertensionGestationalhypertensionBP>=140/90mmHgforfirsttimeduringpregnancyNoproteinuriaBPreturnstonormal<12wkpostpartumFinaldiagnosis

3、madeonlypostpartumMayhaveotherS&Sofpreeclampsia,eg.epigastricdiscomfortorthrombocytopeniaPreeclampsiaMinimumcriteriaBP>=140/90mmHgafter20wkgestationProteinuria>=300mg/24hror>=1+dipstickMildpreeclampsiaSeverepreeclampsiaSeverepreeclampsiaBP>=160/110mmHgProteinuria5g/24hror>=2+dipsti

4、ck(persistent)Cr>1.2mg/dlPlatelets<100,000/mm3MicroangiopathichemolysisElevatedALTorASTPersistentheadache,visualdisturbance,epigastricpainEclampsiaSeizuresthatcannotbeattributedtoothercausesinawomanwithpreeclampsiaSeizuresaregeneralizedMayappearbefore,duringorafterlabor10%developaf

5、ter48hrpostpartumSuperimposedpreeclampsiaNewonsetproteinuria>=300mg/24hrinhypertensivewomenbutnoproteinuriabefore20wkAsuddenincreaseinproteinuriaorBPorplateletcount<100,000inwomenwithhypertensionandproteinuriabefore20wkChronichypertensionBP>=140/90mmHgbeforepregnancyordiagnosedbefo

6、re20wk,notattributabletoGTDorHypertensionfirstdiagnosedafter20wkandpersistentafter12wkpostpartumDiagnosisGestationalHTAlsocalledtransientHTFinalDx:afterdelivery,byexclusionBP:restingBP,KorotkoffphaseVisusedtodefineddiastolicpressureGHTmaylaterdeveloppreeclampsia10%ofeclampticseizur

7、esdevelopbeforeovertproteinuriaisidentifiedBPrise,increasebothmotherandfetusrisksPreeclampsiaDescribedas“pregnancy-specificsyndromeofreducedorganperfusionsecondarytovasospasmandendothelialactivation”Proteinuria&glomerularpathologydeveloplateinthecourse,pathophysiologicprocessbegina

8、searlyasimplantationPreecl