產(chǎn)科學(xué)英文課件：6 妊娠合并肝炎、糖尿病

1、Pregnancy complicates Viral Hepatitis妊娠合并病毒性肝炎,Function of liver,products and secrets proteins Play roles in metabolism of carbohydrates, lipids Synthesizes coagulation factors I, II, V, VII, VIII, IX, X and XI, as well as protein C, protein S and antithrombin. produces and excretes bile (which help

2、 the absorption of vitamin K from the diet) breakdown of insulin and other hormones Etc.,2,Viral hepatitis:,Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Other viruses,3,Symptoms of viral hepatitis,4,Symptoms of viral hepatitis,5,Hepatitis A,6,Hepatitis B:,7,Hepatitis B:,8,Hepatitis B:

3、,9,Hepatitis C:,10,Hepatitis D:,11,Hepatitis E:,12,A gift,an interesting website: /wiki/File:Viral_hepatitis.webm,13,Differential diagnosis,ICP (intrahepatic cholestasis of pregnancy) HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) Acute fatty liver of pregna

4、ncy,14,Treatment,Anti-viral therapy Medication for protection of liver Labor and delivery Breast-feeding,15,Prophylaxis,HBV immunoprophylaxis Vaccines for people at high-risk of contacting HBV infection Mother：Be passively immunized with hepatitis B Ig(HBIg) in the third trimester (50%) Infant: rece

5、ive combined therapy with HBIg and vaccination,16,Key words,Vertical transmission Differential diagnosis of viral hepatitis,17,Gestational Diabetes Mellitus（GDM) 妊娠期糖尿病,上海交大醫(yī)學(xué)院附屬仁濟醫(yī)院婦產(chǎn)科 張羽 博士，副主任醫(yī)師 2016年2月26日,Classification,Gestational diabetes: diagnosed during pregnancy（90%） Overt diabetes during

6、pregnancy(10%) to have diabetes before pregnancy,19,DM is a metabolic disorder characterized by hyperglycemia The cause of DM is multifactorial (genetic, immune, environmental, viral,) GDM: 1%5% in China 3%-10% in USA,20,Effects of pregnancy on glucose metabolism/diabetes,1.Diatary habits changes 2.

7、Insulin load increase 3.Anti-insulin hormones from placenta prolactin estrogen progesterone insulinase,21,Maternal effects,Glucosuria Hyperglycemia Diabetes ketoacidosis Infection PIH/Preeclampsia Nephropathy(腎?。?，retinopathy(視網(wǎng)膜病） Neuropathy（神經(jīng)?。?22,Fetal /neonatal effects,Abortion Preterm delivery

8、Congenital anomalies, malformations Macrosomia Hydramnios(羊水過多） Respiratory distress Hypoglycemia, Hypocalcemia Hyperbilirubinemia (高膽紅素血癥） Polycythemia(紅細胞增多癥）,23,Diagnosis of Overt diabetes during pregnancy,Has a diabetes history; Or High risk patients with one of the following: FPG(fasting plasma

9、 glucose)7.0mmol/L HbA1C 6.5% Random plasma glucose 11.1mmol/L and FPG 7.0mmol/L or HbA1C 6.5% in the next day,24,Diagnosis of GDM,All pregnacy women should be screened for GDM between 24-28 weeks gestation FBG(fasting blood-glucose)=5.1 mmol/L twice after 24 weeks of gestation,25,Diagnosis of GDM,O

10、n women with FBG=7.8 mmol/L),26,Diagnosis of GDM,On women exceeding the glucose threshold value(=7.8 mmol/L) on GCT. Oral glucose tolerance test(OGTT): Fasting for at least 8 hour, 75g-oral glucose load O-hour 5.1 mmol/L 1-hour 10.0 mmol/L 2-hour 8.5 mmol/L Be diagnosed If any one or more serum gluc

11、ose values meet or exceed,27,Whites classification of DM in pregnancy,A: GDM (A1, A2 ) B: onset at 20 years of age or duration of 10 years C: onset at 10-19 years of age or duration of 10-19 years D: onset at 10 years of age or duration of 20 years or any onset or duration with background retinopath

12、y or hypertension only,28,Whites classification of DM in pregnancy,F: Nephropathy(500mg protein per day at 20 weeks of pregnancy H: Arteriosclerotic heart disease, clinically evident R: proliferative diabetic retinophy or vitreous hemorrhage T: history of renal transplant,29,Treatment,Education Stan

13、dard dietary to provide the necessary nutrients to control glucose level to prevent starvation ketosis daily caloric intake: 30Kcal/Kg/Day+300-500cal Exercise Insulin therapy Monitor of blood glucose level,30,Treatment,Plasma glucose level target: 30 before three meals 5.3 mmol/L 2h after three meals 6.7 mmol/L,31,Treatment,Obstetrical management maternal