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Pregnancy-induced hypertension syndrome (PIH). 妊娠高血压综合征. pathogenesis. The factors of PIH

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pathogenesis
pathogenesis
  • The factors of PIH
  • the theories of pathogenesis A utero-placental ischemia theory B Neuro-endocrine theory C immunological theory(ABO;HLA) D DIC theory E others : endothelin(ET--内皮素)

calcium shorting

pathophysiologic changes
Pathophysiologic changes

Widespread arteriolar spasm

three main symptoms:

hypertension

proteinuria

edema

pathologic changes in main organs
Pathologic changes in main organs ①
  • Brain : localized and spot hemorrhage

(局灶性,点状出血)

thrombosis(栓塞)

softening (软化)

  • heart : fibrin thrombi (纤维栓塞)

focal necrosis (灶性坏死)

pathologic changes in main organs1
Pathologic changes in main organs ②
  • Liver : periportal hemorrhagic necrosis

(门脉周围出血坏死)

  • kidneys :
  • placenta : atherosclerosis

IUGR--intrauterine growth retardation

(宫内发育迟缓)

unclassification
unclassification
  • Edema : edema spreading to the thighs or above
  • proteinueia : (+) or more
  • chronic hypertension
clinical findings
Clinical findings
  • Mild PIH syndrome
  • moderate PIH syndrome
  • severe PIH syndrome

prepartal eclampsia (产前子痫)

partal eclampsia ( 产时子痫)

postpartal eclampsia (产后子痫)

diagnosis
diagnosis
  • History hypertension

proteinuria

  • sign edema

symptom

convulsion , coma

blood examination

  • assistant liver and renal functions

examination funduscopy of eyes

others

differential diagnosis
Differential diagnosis
  • Essential hypertension and chronic nephritis
  • convulsive disorders
influence on mother and fetus
Influence on mother and fetus
  • On mother :

HELLP syndrome

hemolysis( 溶血)

elevated liver enzymes(肝酶升高)

lowplatelet count(血小板减少)

  • On fetus :
prevention
Prevention
  • The prenatal care in time
  • adequate nutrition and rest
  • the predetective diagnosis :

mean arterial blood pressure

roll over test

blood variation

calcium amount in urine

management
Management
  • Mild cases A rest B diet C medication :

phnobarbital (苯巴比妥)

diazepam(安定)

moderate and severe cases
Moderate and severe cases 
  • A antiseptic medicine

magnesium sulfate(硫酸镁)

  • B sedative drugs

hibernation mixture I(冬眠1号)

diazepam

  • C antihypertensive drugs
  • D expansive volume treatment

albumin (白蛋白)

plasma (血浆)

whole blood(全血)

moderate and severe cases1
Moderate and severe cases 
  • E Diuretics:furosemide(速尿)

20%mannitol(甘露醇)

  • F Termination of pregnancy

a indications :

b methods :induction of labor (引产)

cesarean section(剖宫产)

  • G The management of eclampsia

a controlling convulsion

b nursing

c closely monitoring

slide18
病 例

张平,女,36岁,以“停经九个月,胎动五个月,双下肢浮肿两周,头晕眼花一小时。”为主诉入院。早孕反应及胎动如期出现,两周前无明显诱因双下肢浮肿,休息后无好转。一小时前出现头晕眼花。既往无高血压,慢性肾炎病史。

查体:T36.7℃,P78次/分,BP175/110mmHg, 心肺听诊无异常,腹膨隆,足月腹型,LOA,浮肿+++。

实验室检查:血常规示PL258G/L,HGB108g / L,HCT0.45。尿常规示蛋白+++。

辅助检查:B超示BPD9.0cm,FL7.2cm,胎盘钙化Ⅱ级。NST有反应型。