PREECLAMPSIA-Reinaldo Figueroa, MD课件.ppt

PREECLAMPSIA Reinaldo Figueroa, MD Winthrop-University Hospital PREECLAMPSIA Hypertensive disorder specific to pregnancy affects nearly 6% of all pregnancies a major cause of maternal and neonatal mortality and morbidity 15 to 20 % of maternal mortality in developed countries PREECLAMPSIA Severity ranges from: a mild disorder transient hypertension in the later part of the pregnancy to a life-threatening disorder with seizures, HELLP syndrome, fetal hypoxia, and growth retardation more severe disease: 0.56 per 1000 deliveries PREECLAMPSIA Predisposes women to other serious complications: placental abruption acute renal failure cerebral hemorrhage disseminated intravascular coagulation circulatory collapse PREECLAMPSIA The etiology is unknown believed to be involved: immune maladaptation placental ischemia oxidative stress genetic susceptibility PREECLAMPSIA Classification of hypertension in pregnancy Gestational hypertension Preeclampsia / eclampsia Chronic hypertension Preeclampsia superimposed on chronic hypertension PREECLAMPSIA Definition of hypertension a systolic blood pressure of 140 mmHg or above, or a diastolic blood pressure of 90mmHg or above, on two occasions 6 hours apart Abnormal proteinuria the excretion of 300 mg or more of protein in 24 hours PREECLAMPSIA Criteria for severe preeclampsia Blood pressure: 160 mmHg systolic or 110 mm Hg diastolic Proteinuria: 5 g in 24 hours Persistent and severe cerebral or visual disturbances headache, scotoma, blurred vision Persistent and severe epigastric pain or right upper quadrant pain PREECLAMPSIA Criteria for severe preeclampsia Pulmonary edema or cyanosis Oliguria 500 mL of urine in 24 hours Eclampsia grand mal seizures HELLP syndrome PREECLAMPSIA Screening tests for gestational hypertension routine components of antepartum care trimester early detection of vasoconstriction early detection of altered renal function early detection of altered hemodynamics detection of placental hyp