bmedicalcomplicationsofpregnancy妊娠内科合并症.pptxVIP

BMedicalComplicationsofPregnancy妊娠内科合并症会计学Objectives目 的Describe selected medical emergencies exclusive to pregnancy描述仅在妊娠出现的医疗急症Describe selected medical conditions that can cause serious complications in pregnancy描述可能危及生命的妊娠合并症Formulate a plan for diagnosis and treatment of these conditions制定诊断及治疗的计划Conditions That Complicate Pregnancy使妊娠复杂化的症状Conditions Exclusive to Pregnancy仅在妊娠出现的症状Deep venous thrombosis (DVT)深静脉血栓Pulmonary embolism (PE)肺栓塞Disseminated intravascular coagulation (DIC)弥漫性血管内凝血Human immunodeficiency virus (HIV) infection HIV感染Severe pre-eclampsia严重子痫前期Eclampsia子痫HELLP syndromeHELLP综合征Acute fatty liver of pregnancy (AFLP)妊娠期急性脂肪肝Hypertensive Disorders of Pregnancy妊娠相关高血压症6-8% of all gestations妊娠的6-8%Chronic Hypertension (Elevated BP prior to 20 weeks)慢性高血压（妊娠前20周血压升高）Pregnancy Induced Hypertension妊高症PIH无蛋白尿(no proteinuria)Preeclampsia 子痫前期(proteinuria +/- edema)蛋白尿水肿HELLP SyndromeHELLP综合征Severe Preeclampsia严重子痫前期Eclampsia子痫Pre-Eclampsia子痫前期Classic Triad:经典三联征Hypertension (140/90)高血压Proteinuria (1+ or 300 mg/24h)蛋白尿Generalized edema (least reliable)广泛性水肿Hypertension and proteinuria must be present on two occasions 6 hr apart高血压和蛋白尿需在至少间隔6小时、二次以上Rapid weight gain is supportive evidence 体重迅速增加支持诊断Diagnostic Criteria for Severe Preeclampsia严重先兆子痫的诊断标准Headaches 头痛Visual Disturbances 视力紊乱Pulmonary Edema 肺水肿Hepatic Dysfunction 肝功异常RUQ or Epigastric Pain右上腹或上腹痛Oliguria少尿Elevated Creatinine肌酐上升Proteinuria of 5 g or more in 24 hrs24小时尿蛋白5g以上Systolic BP收缩压 160 to 180 mm HgDiastolic BP舒张压 110 mm HgThrombocytopenia or hemolysis血栓性血小板减少或溶血Risk Factors for Preeclampsia先兆子痫的危险因素NulliparityMaternal age 40Twin gestationFamily history of pre-eclampsia or eclampsiaChronic hypertensionChronic renal diseaseAntiphospholipid syndromeDiabetes mellitusAngiotensin gene T235初产妇母年龄超过40岁双胎以前妊娠有先兆子痫慢性高血压慢性肾病抗磷脂综合征糖尿病血管紧张素T235基因Prevention: No Proven Benefit预防：尚未证明获益Correct nutritional deficiencies改善营养缺乏 Magnesium镁Zinc锌Omega 3 fatty acids 欧米茄3脂肪酸Change prostacyclin / thromboxa