妊娠期高血压疾病.pptxVIP

HypertensiveDisorders

inPregnancyTengYinChengShanghaiJiaotongUniversityAffiliatedSixthPeoplesHospital,DeptofObsGyn

ContentsEtiologyPathogenesisClinicalfeaturesPhysiopathologyClassificationDiagnosisManagement234561

IncidenceandRiskFactorsIncidenceCommonlyabout5percentMarkedlyinfluencedbyparityRelatedtoraceandethnicity—AgeneticpredispositionMainRiskFactorsNulliparous(初产妇)MultiplepregnancyHistoryofchronichypertensionMaternalageover35yearsObesityLowersocioeconomicstatus…

EtiologyandPathogenesisRoberts,J.M.etal.Hypertension2005;46:1243-1249UsedwithpermissionstagemodelofthepathophysiologyofpreeclampsiaStage2developsinsome,butnotallwomenwithstage1

EtiologyandPathogenesisFaultyPlacentation(胎盘形成不良)---StageIvesselremodeling(血管重铸)ofthedeciduaandmyometriumtransformingintolarge-capacitance,low-resistancevesselsNormal:incompleteremodelinglimitedtothesuperficialdeciduamyometrialsegmentsremainnarrowPreeclampsia:

Incompletevesselremodeling→Reducedplacentalperfusion→placentaischemia（缺血）andhypoxemia（缺氧）→Oxidativedistress→Endotheliadysfunction→affectedproductionofNitricOxide/Prostaglandins（前列腺素）Oxidativedistress（氧化应激）01ImmunesystemdysfunctionGeneticpredispositionMalnutritionOtherfactors02EtiologyandPathogenesis

PathogenesisofpreeclampsiaGeneticfactorsimmunologicalfactorsMaternalvasculardiseaseEnvironmentalfactorsReduceduteroplacentalperfusionFaultyplacentationEndothelialactivationSystemicvasculardysfunctionCapillaryleakvasospasmHypertensionCerebraledema(eclampsia)EdemaProteinuriaCoagulationabnormalities(HELLP)Fetalgrowthrestriction(FGR)

Physiopathology

------sgageIIBasicchange:SystemVasospasm（全身小动脉痉挛）Hemorrhage,edema,hyperemia充血,thrombosisVisualdisturbances:blurredvision,blindness,retinaldetachment（视网膜脱落）Reducedrenalperfusionandglomerularfiltration肾小球滤过率Proteinur