PIH妊娠高血壓綜合征——婦產(chǎn)科學(xué)

1、1會計學(xué)PIH妊娠高血壓綜合征妊娠高血壓綜合征婦產(chǎn)科學(xué)婦產(chǎn)科學(xué)NO、PGI2擴血管擴血管/縮血管失衡縮血管失衡.Risk FactorsFACTORRISK RATIONulliparity3:1Age 403:1African American1.5:1Chronic hypertension10:1Renal disease20:1Antiphospholipid syndrome10:1Risk FactorsFACTORRISK RATIOFamily history of PIH5:1Diabetes mellitus2:1Twin gestation4:1Older Criteri

2、a for Gestational HTN n30/15 increase in BP over baseline levelsnNo longer appropriaten73% of patients will exceed 30 mm systolic and 57% will exceed 20 mm diastolicForms of HTN in PregnancynGestational HypertensionnPreeclampsianChronic HypertensionnAs a group these occur in 12 to 22% of pregnant pa

3、tients and are directly responsible for approximately 18% of maternal mortality nationally.Chronic HypertensionnPre-existing hypertensionnHypertension before 20 weeks in the absence of gestationnIf hypertension persists beyond 6 weeks postpartumPreeclampsianHypertension after 20 weeks of gestationnP

4、roteinuria- 300mg nEdemanBP 160 systolic or 110 diastolicn5grams of protein in 24 hour urinenOligurianCerebral of visual distrubancesnPulmonary edema or cyanosisnEpigastric or RUQ painnImpaired liver functionnThrombocytopenianIUGR 對母兒的影響對母兒的影響對母體的影響對母體的影響Pulmonary EffectsnCapillary leaknReduced coll

5、oid osmotic pressurenPulmonary edemaHematologic EffectsnVolume contractionnElevated hematocritnLow plateletsnAnemia due to hemolysisRenal EffectsnDecreased glomerular filtration ratenIncreased BUN/creatininenProteinurianOligurianAcute tubular necrosisHELLP SyndromenHe-hemolysisnEL-elevated liver enz

6、ymesnLP-low plateletsHELLP SyndromenIs a variant of severe preeclampsianPlatelets 100,000nMay occur against a background of what appears to be mild diseaseFetal EffectsnIncreased perinatal morbiditynPlacental abruptionnFetal growth restrictionnOligohydramniosnFetal distress 對胎兒的影響對胎兒的影響LabetalolnDos

7、e: 20mg, then 40, then 80 every 20 minutes, for a total of 220mg nOnset: 1-2 minutesnDuration: 6-16 hoursnSide effects: hypotensionnMechanism: Alpha and Beta blockNifedipinenDose: 10 mg po, not sublingualnOnset: 5-10 minutesnDuration: 4-8 hoursnSide effects: chest pain, headache, tachycardianMechani

8、sm: CA channel blockSeizure ProphylaxisnMagnesium sulfaten4-6 g bolusn1-2 g/hournMonitor urine output and DTRsnWith renal dysfunction, may require a lower doseMagnesium SulfatenIs not a hypotensive agentnWorks as a centrally acting anticonvulsantnAlso blocks neuromuscular conductionnSerum levels: 6-

9、8 mg/dLPreventionnLow dose ASA ineffective in patients at low risknCalcium supplementation is ineffective (2.0 g of calcium gluconate per day)nNo compelling evidence that either are harmfulnRecent study done with antioxidant (1,000mg VitC and 400mg VitE). nSmall study that needs to be confirmed.Forms of HTN in PregnancynGestational HypertensionnPreeclampsianChronic HypertensionnAs a group these occur in 12 to 22% of pregnant patients and are directly responsible for approximately 18% of maternal mortality nationally. 對母兒的影響對母兒的影響Renal EffectsnDecreased glomerula