妊高症等课件
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There are no specific findings unless congestive heart failure is present. 2.Abdominal examination
check for liver tenderness(subcapsular hemorrhage) note if ascites is present. 3. Eyeground examination
2.Roll-over test(ROT) should be performed at 28 to 32
weeks. The patient is placed in the left lateral recumbent position, and BP is taken every 5 minutes until the systolic and diastolic reading are stable. The patient is then rolled flat on her back, and the Bp is taken immediately and at 5-minute intervals. Among patients in whom the diastolic BP increase by more than 20 mmHg, as high as 93 percent will develop preeclampsia. If the diastolic BP increase less than 20 mmHg, Preeclampsia probably will not develop.
2.Moderate
Recognized in a patient with hypertension who has an BP greater than 140/90mmHg and less than 160/110mmHg . This increase in BP is combined with appreciable proteinura, while edema of the lower extremities is usually, but not always, present.
3. Severe. Preeclampsia
Hypertension exceeding an BP of 160/110mmHg. on at least two occasions 6 hours apart with the patient at bed rest, and proteinuria of greater than 5mg/24h; uaually accompanied by headaches and blurred vision. If right upper quadrant or epigastric. pain. oliguria, pulmonary edama, or visual or cerebral disturbances occur, severe disease is present. Edema of the face, hands, and lower extremities is usually present.
Hypension (mmHg)
BP≥ 140/90mmHg
Mild-PIH Or ≥ 30/15 over
Baseline value
Moderate- BP≥ 150/00mmHg PIH and <160/110mmHg
SeverePIH BP≥ 160/110mmHg
preeclampsia eclampsia
(MAP: mean arterial pressure)
二、Cause of disease:
1. Risk factors for PIH (1)first pregnancy. (2)multiple gestation (3)polyhydramnios (4)hydatidiform mole (5)malnutrition (6)positive family history of PIH (7)psychoactive (8)airtemperature change 2.Pathogenesis theory (1)uterine placenta ischemic theory (2)neurocrine theory (3)immunity theory (4)DIC (5)the others…….
Section 5 Pregnancy-induced hypertension Syndrome(PIH)
一、Definition:
A rise in the MAP above 106mmHg (eg.,140/90mmHg) after 20weeks of pregnancy and (0r) Proteinuria and (or) edema, even convulerion and coma. The hypertension disappears after delivery. PIH is one of important deathly cause of gravida-parturient and perinatal infant.
五、Diagnosis
1.history
(1)past medical history (2)familial inheritance history (3)pregnant history (4)frequently-occuring fector
2.clinical symptom
classification
2.Moderate and Severe
(1)Anticonvulsive therapy Magnesium sulfate(therapy) is the drug of choice.
A:Method
a.Loading dose for seizure prophylaxis is 4 to 6g of Mg SO4 IV over 20 minutes and continued at 1-1.5g /hour.
1.Mild. PIH. Recognized when (a) the BP is less than
140/90mmHg; or the Bp is less than 30/15mmHg over baseline value.(b ) proteinuria and (or)edema develops. This definition requires accurate knowledge of the patient’s blood pressure (BP) reading at prior points in her pregnancy.
Proteinuria (g) (± )
(+) ≥ 0ຫໍສະໝຸດ Baidu5g/24h
(++~++++)
≥ 5g/24h
edema
With or
without
With or
without
With or
without
Subjective symptom without
without
With
3.Laboratory tests
Rising values are ominous. Falling valuves suggest clinical improvement.
六、 Prevention
Preliminary examination
1.mABP(MAP)
mABP=(systolicBP+diastolic BP 2) 3
4. Complication of PIH
(1)nephric function disorder (acute renal failure) (2)placental abruption (3)intrauterine fetal growth retardation (IUGR) (4)fetal distress (5)hepatic rupture (6)pulmonary edema. (7)cerebral hemorrhage. (8)retinal detachment
七、Therapy
1.Mild.
A: Bed rest: Bathroom privileges may be allowed. B:Sedation:Patients are allowed to relax. Help lower blood pressure, and reduce the likelihood of convulsion. C:eating: lower salt, enough protein.
三、Pathologic histology changes in the chief organ
The baseline pathophysiology changes are all the small arteria spasm in pregnancy women with PIH. 1.Cardiovascular-respiratory examination.
Eclampsia.
Generalized seizure accompanied by hypertension and proteinuria in a pregnant patient. Other seizure etiologies such as epilepsy, drup withdrawal. Or cardiovascular accident must be excluded. The seizure may occur up to 24 hours into the postpartum period; indeed, the initial eclamptic fit frequently occurs during the postpartum period. Eclamptic seizures do not correlate well with the level of hypertension.
Check for eyeground of retinopathy of pregnancy and hypertension syndrome
四、Classification
This diagnosis requires hypertension and proteinuria with or without edema. Usually, this disease occurs in primigravidas and occurs initially after the twentieth week of pregnancy.
a: complete blood count(CBC) b: liver enzymes(in normal pregnancy. Serum glutamicoxaloasetic transaminase[SGOT], SGPT、LDH……) c: Uric acid (less than 6mg/100 ml is normal in pregnancy) d: start a 24-hour urine collection for creatinine clearance (130-160ml/min in normal pregnancy) and total protein (less than 300mg/24 hour normal pregnancy) e:Coagulation status with platelet count, PT. PTT. f:Blood urea nitrogen(BUN) and serum creatinine. g: Daily hematocrits.
check for liver tenderness(subcapsular hemorrhage) note if ascites is present. 3. Eyeground examination
2.Roll-over test(ROT) should be performed at 28 to 32
weeks. The patient is placed in the left lateral recumbent position, and BP is taken every 5 minutes until the systolic and diastolic reading are stable. The patient is then rolled flat on her back, and the Bp is taken immediately and at 5-minute intervals. Among patients in whom the diastolic BP increase by more than 20 mmHg, as high as 93 percent will develop preeclampsia. If the diastolic BP increase less than 20 mmHg, Preeclampsia probably will not develop.
2.Moderate
Recognized in a patient with hypertension who has an BP greater than 140/90mmHg and less than 160/110mmHg . This increase in BP is combined with appreciable proteinura, while edema of the lower extremities is usually, but not always, present.
3. Severe. Preeclampsia
Hypertension exceeding an BP of 160/110mmHg. on at least two occasions 6 hours apart with the patient at bed rest, and proteinuria of greater than 5mg/24h; uaually accompanied by headaches and blurred vision. If right upper quadrant or epigastric. pain. oliguria, pulmonary edama, or visual or cerebral disturbances occur, severe disease is present. Edema of the face, hands, and lower extremities is usually present.
Hypension (mmHg)
BP≥ 140/90mmHg
Mild-PIH Or ≥ 30/15 over
Baseline value
Moderate- BP≥ 150/00mmHg PIH and <160/110mmHg
SeverePIH BP≥ 160/110mmHg
preeclampsia eclampsia
(MAP: mean arterial pressure)
二、Cause of disease:
1. Risk factors for PIH (1)first pregnancy. (2)multiple gestation (3)polyhydramnios (4)hydatidiform mole (5)malnutrition (6)positive family history of PIH (7)psychoactive (8)airtemperature change 2.Pathogenesis theory (1)uterine placenta ischemic theory (2)neurocrine theory (3)immunity theory (4)DIC (5)the others…….
Section 5 Pregnancy-induced hypertension Syndrome(PIH)
一、Definition:
A rise in the MAP above 106mmHg (eg.,140/90mmHg) after 20weeks of pregnancy and (0r) Proteinuria and (or) edema, even convulerion and coma. The hypertension disappears after delivery. PIH is one of important deathly cause of gravida-parturient and perinatal infant.
五、Diagnosis
1.history
(1)past medical history (2)familial inheritance history (3)pregnant history (4)frequently-occuring fector
2.clinical symptom
classification
2.Moderate and Severe
(1)Anticonvulsive therapy Magnesium sulfate(therapy) is the drug of choice.
A:Method
a.Loading dose for seizure prophylaxis is 4 to 6g of Mg SO4 IV over 20 minutes and continued at 1-1.5g /hour.
1.Mild. PIH. Recognized when (a) the BP is less than
140/90mmHg; or the Bp is less than 30/15mmHg over baseline value.(b ) proteinuria and (or)edema develops. This definition requires accurate knowledge of the patient’s blood pressure (BP) reading at prior points in her pregnancy.
Proteinuria (g) (± )
(+) ≥ 0ຫໍສະໝຸດ Baidu5g/24h
(++~++++)
≥ 5g/24h
edema
With or
without
With or
without
With or
without
Subjective symptom without
without
With
3.Laboratory tests
Rising values are ominous. Falling valuves suggest clinical improvement.
六、 Prevention
Preliminary examination
1.mABP(MAP)
mABP=(systolicBP+diastolic BP 2) 3
4. Complication of PIH
(1)nephric function disorder (acute renal failure) (2)placental abruption (3)intrauterine fetal growth retardation (IUGR) (4)fetal distress (5)hepatic rupture (6)pulmonary edema. (7)cerebral hemorrhage. (8)retinal detachment
七、Therapy
1.Mild.
A: Bed rest: Bathroom privileges may be allowed. B:Sedation:Patients are allowed to relax. Help lower blood pressure, and reduce the likelihood of convulsion. C:eating: lower salt, enough protein.
三、Pathologic histology changes in the chief organ
The baseline pathophysiology changes are all the small arteria spasm in pregnancy women with PIH. 1.Cardiovascular-respiratory examination.
Eclampsia.
Generalized seizure accompanied by hypertension and proteinuria in a pregnant patient. Other seizure etiologies such as epilepsy, drup withdrawal. Or cardiovascular accident must be excluded. The seizure may occur up to 24 hours into the postpartum period; indeed, the initial eclamptic fit frequently occurs during the postpartum period. Eclamptic seizures do not correlate well with the level of hypertension.
Check for eyeground of retinopathy of pregnancy and hypertension syndrome
四、Classification
This diagnosis requires hypertension and proteinuria with or without edema. Usually, this disease occurs in primigravidas and occurs initially after the twentieth week of pregnancy.
a: complete blood count(CBC) b: liver enzymes(in normal pregnancy. Serum glutamicoxaloasetic transaminase[SGOT], SGPT、LDH……) c: Uric acid (less than 6mg/100 ml is normal in pregnancy) d: start a 24-hour urine collection for creatinine clearance (130-160ml/min in normal pregnancy) and total protein (less than 300mg/24 hour normal pregnancy) e:Coagulation status with platelet count, PT. PTT. f:Blood urea nitrogen(BUN) and serum creatinine. g: Daily hematocrits.