妇产科学精品课件妊娠高血压疾病.ppt 58页

Hypertension Disorders Complicating Pregnancy 妊娠期高血压疾病 Characteristics Hypertension disorders complicating pregnancy Pathophysiology Category and clinical manifestation Diagnosis and differential diagnosis Management and prevention Pathophysiology Etiology Genetic susceptibility hypothesis Immune maladaptation hypothesis Placental ischemia hypothesis Oxidative stress hypothesis Category and clinical manifestation Gestational hypertension Preeclampsia Eclampsia Chronic hypertension Preeclampsia superimposed on chronic hypertension Management Chronic hypertension Indication: SBP>150-180mmHg; DBP>100mmHg; Hypertension related organ dysfunction IV when BP≥180/110mmHg Phentolaminum 20-100mg ivgtt Management- HELLP syndrome Principle Stabilize the condition Protect the mother and baby Anesthesia local anesthesia or general anesthesia indicated block anesthesia or epidural anesthesia contraindicated ---- bleeding Most HELLP patients recover 96h postpartumn Case presentation Mrs. C. is 23 years old. She is 37 weeks pregnant and has attended the antenatal clinic four times. No abnormal findings were detected during antenatal visits, the last of which was 1 week ago. Her husband has brought her to the emergency department of the district hospital because she developed a severe headache and blurred vision this morning. ASSESSMENT History, Physical Examination, Screening Procedures/Laboratory Tests What will you include in your initial assessment of Mrs. C., and why? What particular aspects of Mrs. C.’s physical examination will help you make a diagnosis or identify her problems/needs, and why? What screening procedures/laboratory tests will you include (if available) in your assessment of Mrs. C., and why? DIAGNOSIS Identification of Problems/Needs blood pressure 160/110 mm Hg, proteinuria 3+. She has a severe headache that started 3 hours ago. Her vision became blurred 2 hours after the onset of headache. She has no upper abdominal pain and has not suffered convu