妊娠高血压HYPERTENSIVE DISORDERS IN PREGNANCY课件.ppt

HYPERTENSIVE DISORDERS IN PREGNANCY DR. SALWA NEYAZI ASSISSTANT PROF KSU/ CONSULTANT OBGYN PEDIATRIC ADOLESCENT GYNECOLOGIST TYPES OF HYPERTENSIVE DISEASE IN PREGNANCY 1-Gestational hypertension 2-PET 3-Eclampsia 4-Chronic hypertension 5-PET superimposed on chronic hypertension 1-Gestational hypertension BP ≥ 140/90 mm Hg for the first time during pregnancy No proteinuria BP returns to N 12 Wk postpartum Final Dx made only postpartum May have other signs of PET eg. Headache, epigastric discomfort or thrombocytopenia PET Minimum criteria BP ≥ 140/90 mm Hg after 20 Wk gestation Proteinuria ≥ 300 mg/24 hrs or ≥ 1+ dipstick Increased certainty of PET BP ≥ 160/110 mm Hg Proteinuria ≥ 2 gm/24 hrs or ≥ 2+ dipstick Serum creatinine 1.2 mg/dl unless known to be previously elevated Platelets 100 000/mm3 Increased certainty of PET Microangiopathic hemolysis (increased LDH) Elevated ALT or AST Persistant headache or other cerebral/ visual disturbance Persistant epigastric pain ECLAMPSIA Seizures that can not be attributed to other causes in a woman with PET. 1% of Pt with PET develop EC CHRONIC HYPERTENSION BP ≥ 140/90 mm Hg before pregnancy or Dx before 20 Wk gestation HPT first Dx after 20 Wk gestation persistant after 12 Wk postpartum PET SUPERIMPOSED ON CHRONIC HYPERTENSION New onset proteinuria ≥ 300 mg/24 hrs in hypertensive women but no proteinuria before 20 Wk gestation A sudden increase in proteinuria or BP or Plt count 100 000/ mm3in women with HPT proteinuria before 20 Wk gestation INCIDENCE RISK FACTORS PET occurs in 6-8% of all live birth RISK FACTORS Extremes of reproductive age 15 35 Y Nulliparity Black race Hx of PET in a 1st degree female relative Hx of PET in prior pregnancy DM Chronic renal disease Ch HPT Multiple pregnancy ? twins 13 vs 6% Hydatidiform mole Nonimmune hydrops fetalis Obesity ? 4.3% ? BMI 19.8 kg/m2 ? 13.3% ? BMI ≥ 35 kg/m2 Smoking ? ↓ risk of HPT PATHOGENESIS Endothelial c