1、浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGOHYPERTENSIVE DISORDERS IN PREGNANCY HuWenShengWomens HospitalSchool of MedicineZhejiang University浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附
2、属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGSpasm of vessels全身小血管痉挛全身小血管痉挛Vessel stenosisHigher periphery resistanceBlood pressure elevateInjury of endotheliocyte内皮损伤及局部缺血内皮损伤及局部缺血ProteinuriaEdemaHypertensionPathology 浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGHypertensionProteinuriaEclampsiaHELLP syndromeIntra-ut
3、erine growth restrictionMulti-organ diseaseCerebral vesselsFetusLiverSystemic blood vesselsKidneys浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG 浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附
4、属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG Gestational hypertension1、Blood pressure140/90mmHg first onset in gestational period and recover within 12 weeks post partum2、Urine protein negative3
5、、Patients may superimpose upper abdominal pain and thrombocytopenia(PL).4、Final diagnosis should be made post partum浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGMinimum criteria:1.Proteinuria 300mg/24 hours or 1+dipstick2.BP140/90mmHg after 20 weeks gestationPreeclampsia浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company
6、 LOGPreeclampsiaIncreased certainty of preeclampsia:BP160/110mmHg Proteinuria 5g/24 hours or 3+dipstick Persistent headache or other cerbral or visual disturbance Persistent epigastric pain Dysfunction of liver Oliguria，Cr level of blood 106 umol/L Hypoproteinemia Blood platelet 100109/L；Microangiop
7、athic hemolysis Pulmonary edema FGR,oligohydramnios Early onset preeclampsiaclampsia浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGEclampsiaSeizures that cannot be attributed to other causes in a woman with preeclampsia浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG Pre-eclampsia superimposed upon chronic hypertens
8、ionNew-onset proteinuria 300mg/24 hours in hypertensive women but no proteinuria before 20 weeks gestationA sudden increase in proteinuria or blood pressure or platelet count 100,000/mm3 in women with hypertension and proteinuria before 20 weeks gestation浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG Chron
9、ic Hypertension1、BP140/90mmHg before pregnancy or diagnosed before 20 weeks gestation.2、Hypertension first diagnosed after 20 weeks gestation and persistent after 12 weeks postpartum浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGTake place more frequently in severe type 1、Mother：Heart failure、placenta abrup
10、tion、cerebrovascular accident、DIC、renal failure、HELLPS syndrome、postpartum hemorrhage2、Fetus：FGR、fetal distress、fetal death、neonatal asphyxia 浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG1.Termination of pregnancy with the least possible trauma to mother and fetus2.B
11、irth of an infant who subsequently thrives3.Complete restoration of health to the motherBasic management objectives浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGTreatment is aimed at preserving the life and health of the mother;the fetus usually also survives.A patient with early signs of mild preeclampsia
12、 may be treated as an outpatient requiring strict bed rest,but she should be seen by her physician every 2 days.浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGIf her condition does not immediately improve,she should be hospitalized.Once the decision to treat preeclampsia with more than bed rest has been mad
13、e,delivery should be the objective.浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGSpasmolysisConscious-sedation DepressurizationDiuresisPregnancy termination 浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGIn severe preeclampsia,more vigor
14、ous therapy is indicated.Then magnesium sulfate 4g is given slowly IV over 15 min until the hyperreflexia that usually accompanies this disorder diminishes,thereby decreasing the risk of seizures.Magnesium sulfate is continued via an IV infusion pump at about 1 to 2g/h,with supplemental doses as nec
15、essary.Therapy is monitored with sequential serum magnesium levels(therapeutic range,1.8 to 3 mmol/L).注意事项注意事项浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGAntihypertensive medications are usually withheld unless the diastolic blood pressure exceeds 100-110mmHg.目标血压：无并发症目标血压：无并发症 130-155mmHg/80-105mmHg 并发症
16、并发症 130-139mmHg/80-89mmHg 浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGA)Parentral drugs:1)Hydralazine:2)Labetalol(Trandate):3)Diaz oxide(Hyperstat):A)Oral drugs:1)-methyl DOPA(aldomet):2)Monohydralazine(Aprisoline):3）-adrenergic blockers:4)Prazocin(minipres):5)Calcium Channel Blocker:浙大医学院附属妇产科医院产科浙大医学院附
17、属妇产科医院产科Company LOGManagement of patients with severe preeclampsia occurring earlier in pregnancy is controversial.Some institutions use diuretics or other antihypertensive drugs to control maternal blood pressure until fetal lung maturity is reached.“34w”浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG Deli
18、very is the definitive mode of therapy if severe preeclampsia develops at or beyond 36 weeks gestation or if there is evidence of fetal lung maturity or fetal jeopardy.If the delivery of a preterm infant(35MultiparaPregnancy women used to tobacco or dopeInitial etiologic agnetDamage of endometriaDev
19、elopment of the trophoblastic layer of fertilized ovum delayedAnomaly of placentaCicatricial uterus due to cesarean section,e.g.浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGClassificationClassified according to the relationship between the edge of placenta and internal os uteri:complete（central）placenta p
20、revia partial placenta previa marginal placenta previaTime to determine classification：the last examination before managed浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG（1）complete placenta previa（2）partial placenta previa（3）marginal placenta previa浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGClinical symptomsnRe
21、peat vaginal bleeding without pain in the 3th trimester of pregnancynAnemia shock or even death corresponded to the volume of vaginal bleedingnAnomaly of fetal conditionnPhysical sign浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGAuxiliary examinationn B-ultrasound examinationn Placenta examination post par
22、tumn MRI浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGDifferential diagnosisPlacental abruptionDisruption of vasa previaCervical polyp or erosionCancer of cervix浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG n Bleeding at or post partumn Implantation of placentan Anemia and puerperal infectionn Premature delivery
23、Complication of mother and fetus浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGn expectant treatment Indication：Fewer vaginal bleeding Patients condition stabilization 36 weeks,or fetal lung function been maturedMode of labor:According to the type of placenta previa,volume of vaginal bleeding and condition
24、of gravia,et al.浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGnTransport in emergency condition In the neighborhood Initiatory management lAny women experiencing vaginal bleeding in late pregnancy must be ecaluated in a hospital capable of dealing with maternal hemorrhage and a compromised perinate.lA vagi
25、nal or rectal examination must not be performed until placenta previa has been ruled out and until preparations are complete for management of massive hemorrhage and maternal or perinatal complications.浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG placental abruption浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG
26、placenta in normal site strip from the uterine parietal partially or completely before the fetus expulsion,after 20 weeks gestation or in the delivery procedure.Incidence rate：0.512.33 Neonatal mortality：200350Definition浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGEtiologyAngiopathy of vasa basalis Mechan
27、ical agent Venous pressure of uterus elevated abruptly Volume of uterus deflated abruptly Others：Age of gravida35,multipara,tobacco,dope浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGClassificationnClassify according to vaginal bleeding or not:Dominant/Recessive/Mixed nClassify according to severity degree:
28、Light type Severe type浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGClinical symptomsAbruptly,persistent abdominal pain with vaginal bleeding Nausea,vomiting,decrease of blood pressure shock（Volume of vaginal bleeding not correspond to patient condition）Anomaly of fetal condition The uterus touched hard wi
29、th pain The size of uterus is bigger than it should be in that gestation age浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGAuxiliary examinationDiagnotic examination:B-ultrasound examination Placenta examination post partum Blood Rt,Blood coagulation,blood examination of hepatic and renal function浙大医学院附属妇产科
30、医院产科浙大医学院附属妇产科医院产科Company LOGComplicationsDIC,dysfunction of coagulation Bleeding post partum,hemorrhagic shock Amniotic fluid embolism Acute renal failure Fetal death浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOGTreatmentTo correct shock condition：Blood transfusion,Antishock Pregnency termination Choose appropriate mode of termination according to patients condition.Prevention of postpartum Management of coagulation disorder Prevention of renal failure浙大医学院附属妇产科医院产科浙大医学院附属妇产科医院产科Company LOG
