【高血压精品英文课件】妊高症 Hypertensive Disorders with Pregnancy.ppt

Hypertensive Disorders with Pregnancy Professor Zouhair O Amarin MD MSc (Med. Sci) MSc (Med. Edu) FRCOGDepartment of Obstetrics and GynaecologyJordan University of Science and Technology Superimposed PE or eclampsia Development of PE or eclampsia in pre-existing hypertension detected by a further increase of 30 mmHg in SBP or 15 mmHg in DBP or New onset proteinuria of 300 mg/24 hours in hypertensive women but with no proteinuria before 20 weeks gestation or A sudden increase in proteinuria or a drop in platelet count to 100,000/mm3 with hypertension and proteinuria before 20 weeks gestation Proteinuria It indicates glomerular damage and almost always occurs after hypertension It is a reliable indicator of fetal morbidity and mortality Significant proteinuria is defined as: One 24-h urine collection with a total excretion of 300 mg or more Two random clean-catch or catheter specimen of urine collected at least 4-6 hours apart with: 2+ or more on reagent strip 1+ if SG 1010 A protein / creatinine index of 300 or more Theories (I) Defective trophoblastic invasion of the spiral arteries (II) Immunologic factor (III) Increased pressor responses (IV) Prostaglandins imbalance (V) Genetic predisposition (VI) Inflammatory factors Many investigators feel that uteroplacental insufficiency is necessary for the development of the disease. - Ischemia could be due to: Underlying vascular changes (hypertensive disease or failure of the normal physiologic changes in the spiral arteries of the uterus) Increased myometrial resistance of the myometrial vessels, which could be related to a heightened myometrial tension produced by the large fetus in a primiparous women, by twins, or by polyhydramnios The poorly perfused trophoblast release “factor X” which enters maternal circulation and causes endothelial dysfunction (serum of women with PET is able to activate and da