BMedicalComplicationsofPregnancy妊娠内科合并症.pptVIP

Medical Complications of Pregnancy妊娠期合并症 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 Exclusive to Pregnancy仅在妊娠出现的症状 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 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 Risk Factors for Preeclampsia先兆子痫的危险因素 Nulliparity Maternal age 40 Twin gestation Family history of pre-eclampsia or eclampsia Chronic hypertension Chronic renal disease Antiphospholipid syndrome Diabetes mellitus Angiotensin gene T235 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 / thromboxane balance: 改变前列环素/血栓烷的平衡 Aspirin阿斯匹林 Management of Severe Preeclampsia严重先兆子痫的处理 Admit to hospital, monitor closely at bedrest 住院卧床休息，密切监测 Treatment goals:治疗的目标 Prevent seizures预防抽搐 Lower BP to prevent cerebral hemorrhage降压预防脑出血 Expedite delivery, balancing maternal condition and fetal maturity 提前分娩，权衡母情况与胎儿成熟的状况 Maternal Evaluation对母亲的评估 Vitals, neuro checks, and DTRs q15-60 min. until stable生命体征、神经系统的检查，深腱反射每15-60分钟一次，直至稳定 Foley catheter - output and dipstick protein hourly foley尿管每小时计量排量和蛋白量 External monitoring – NST 外检测NST Labs: Blood count, BUN, creatinine, AST, ALT, LDH, electrolytes and uric acid 实验室：血常规、BNU、肌酐、肝酶、电解质、尿酸 Meds: MgSO4 IV; BP meds for diastolic 110 药物：静脉硫酸镁，若舒张压110用降压药 Magnesium Sulfate硫酸镁 Preferred anticonvulsant 抗抽搐首选 Slows neuromuscular conduction and decreases CNS i