妊娠期复杂心脏病(八年制).ppt

Accessory examnation liver function test immunological serum markers Coagulation function Gastrointestinal symptoms are severe The rapid deepening jaundice Total cholesterol >171 mmol/L Hepatic odor,The liver was reduced The enzyme isolated bile， white /ball inversion Coagulation disorders, Systemic bleeding tendency Hepatic encephalopathy Hepatorenal syndrome, Acute renal failure Coma Diagnosis of severe hepatitis 5.differential diagnosis Hyperremesis gravidarum Preeclampsia/eclampsia ICP Acute fatty liver of pregnancy Drug induced liver injury 0 -1 - 6 30ug 10ug 10ug 0 -1 - 3 0.5ml 0.16ml 0.16ml 0 -1 - 6 6h -1m/1ml active Passive Vaccination+ HBIG Prvention 75% Prvention 94% Prvention 71% 6.Prevention of Neonatal Infection HBV hospital-acquired infection vertical transmission,no methods to prevent perinatal transmission viral vaccine 0.02 mL/kg dose of immune globulin HCV HAV 7.management principals Severe hepatitis Obstetrics management Dietary changes Rest Protect liver function treatment Prevent infections principals 1. Prevention and treatment of hepatic coma Reduction of blood ammonia To reduce the intestinal absorption of ammonia Diet (protein restriction, increased carbohydrate) relaxing the bowels Drug (neomycin glutamate etc.) To prevent the necrosis of liver cells and promote regeneration Glucagon ,insulin AND glucose combined Severe hepatitis treatment 2. The prevention and treatment of DIC Coagulation factors 4h ~ 12h with heparin prenatal postpartum The prevention of postpartum hemorrhage 3.The treatment of renal failure Water, electrolyte balance , diuretic (500ml) renal vascular expansion Shorten the second stage of labor prevention of postpartum hemorrhage broad-spectrum antibiotic symptomatic treatment HBeAg(+) no breast-feed Acute hepatitis Control of the disease, If necessary, termination of pregnancy gestation period stages of labor