PREGNANCY INDUCED HYPERTENSION：妊娠高血压综合征.ppt

Pathophysiologic Changes Cardiovascular effects Hematologic effects Neurologic effects Hyperreflexia Headache Cerebral edema Seizures Pulmonary effects Renal effects Fetal effects Pathophysiologic Changes Cardiovascular effects Hematologic effects Neurologic effects Pulmonary effects Capillary leak Reduced colloid osmotic pressure Pulmonary edema Renal effects Fetal effects Pathophysiologic Changes Cardiovascular effects Hematologic effects Neurologic effects Pulmonary effects Renal effects Decreased glomerular filtration rate Glomerular endotheliosis Proteinuria Oliguria Acute tubular necrosis Fetal effects Renal Effects Decreased glomerular filtration rate Glomerular endotheliosis Proteinuria Oliguria Acute tubular necrosis Pathophysiologic Changes Cardiovascular effects Hematologic effects Neurologic effects Pulmonary effects Renal effects Fetal effects Placental abruption Fetal growth restriction Oligohydramnios Fetal distress Increased perinatal morbidity and mortality Management The ultimate cure is delivery Assess gestational age Assess cervix Fetal well-being Laboratory assessment Rule out severe disease!! Gestational HTN at Term Delivery is always a reasonable option if term If cervix is unfavorable and maternal disease is mild, expectant management with close observation is possible Mild Gestational HTN not at Term Rule out severe disease Conservative management Serial labs Twice weekly visits Antenatal fetal surveillance Outpatient versus inpatient Indications for Delivery Worsening BP Nonreassuring fetal condition Development of severe PIH Fetal lung maturity Favorable cervix Unfavorable Cervix No contraindication to prostaglandin agents If 32 weeks, consider cesarean When favorable, oxytocin Hypertensive Emergencies Fetal monitoring IV access IV hydration The reason to treat is maternal, not fetal May require ICU Criteria for Treatment Diastolic BP 105-110 Systolic BP 200 Avoid rapid reduction in BP Do not attempt to normalize BP Goal is DBP 1