2012年南京市市政基础设施工程安全生 .43.ppt

Medical and Surgical Complications during Pregnancy Effect of pregnancy on heart disease Clinical Classification (By the New York Heart Association) Clinical Classification (con’t) Diagnosis of heart disease Symptoms Medical and Surgical Complications during Pregnancy Effect of pregnancy on hepatitis Effect on pregnancy Diagnosis Diagnosis of severe acute hepatitis Defferential diagnosis Medical and Surgical Complications during Pregnancy Urinalysis is essential. Most degree that proteinuria must exceed 500mg/day to be considered abnormal for pregnancy. If the serum creatinine persistently exceeds 0.9mg/dl (75umol/L), then intrinsic renal disease should be suspected. Ultrasonogaphy provides imaging of renal size and relative consistency,as well as elements of obstruction. If necessary,cystoscop, intravenous pyelography, or renal biopsy may be considered. Assessment of Renal Disease During Preg1ancy Incidence About 1-2% of pregnancies. Acute Pyelonephritis is the most common serious medical complication of pregnancy. Pyelonephritis is more common after midpregnancy.It is unilateral and right-sided in more than half of cases,and bilateral in one fourth. In most women, renal parenchymal infection is caused by bacteria that ascend from the lower tract. Acute Pyelonephritis Effect on pregnancy The high fever can creates abortion, preterm labor. In the first trimester, malformations are increase. (such as spinal defects) Toxic shock.(by bacteria toxin) Clinical findings General symptoms: The onset of pyelonephritis is usually rather abrupt. High fever (as well as 40degree C), Shaking chills.(thermoregulatory instability) Nausea and vomiting Headache Clinical findings(con’t) Urinary systemic symptoms: Aching pain in one or both lumbar regions. Tenderness in one or both costovertebral angles (by percussion) Dysuria,urgency,and frequency. Asymptomatic bacteriuria The rep