妊娠高血壓PPT檔-高雄榮民總醫院.ppt

PIH 高雄榮總婦產部 李如悅 Preview Obstetrics deadly triad: hemorrhage, infection, preeclampsia Incidence: 3.7-5% 16% of 3201 pregnancy-related deaths in the United States from 1991-1997 TABLE 34-1 Diagnosis of Hypertensive Disorders Complicating Pregnancy Gestational hypertension BP≧ 140/90mm Hg for first time during pregnancy No proteinuria BP returns to normal 12 weeks’ postpartum Final diagnosis made only postpartum May have other signs or symptoms of preeclampsia, for example, epigastric discomfort or thrombocytopenia Preeclampsia Minimum criteria BP ≧ 140/90mm Hg after 20 weeks’ gestation, 2 measurements a minimum of 6 hours apart Proteinuria ≧ 300 mg/24 hours or ≧ 1+ dipstick of two urine specimens collected at least 4 hours apart Increased certainty of preeclampsia BP ≧ 160/110 mg Hg Proteinuria 2.0 g/24 hours or ≧ 2+ dipstick Serum creatinine 1.2 mg/dL unless known to be previously elevated Platelets 100,000/mm3 Microangiopathic hemolysis (increased LDH or schistocytes or helmet cells on peripheral blood smear) Elevated ALT or AST Persistent headache or other cerebral or visual disturbance Persistent epigastric pain Eclampsia Seizures that cannot be attributed to other causes in a woman with preeclampsia Superimposed Preeclampsia (on chronic hypertension) New-onset proteinuria ≧ 300mg/24 hours in hypertensive women but no proteinuria before 20 weeks’ gestation A sudden increase in proteinuria or blood pressure or platelet count 100,000/mm3 in women with hypertension and proteinuria before 20 weeks’ gestation Chronic Hypertension BP ≧ 140/90 mm Hg before pregnancy or diagnosed before 20 weeks’ gestation not attributable to gestational trophoblastic disease or Hypertension first diagnosed after 20 weeks’ gestation and persistent after 12 weeks’ postpartum Etioloty Abnormal trophoblastic invasion In normal implantation uterine spiral arteries undergo extensive remodeling as they are invaded by endovascular trophoblasts In preeclampsia Incomple