高血压英文ppt精品课件diagnosis of hypertensive disorders

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1、PIH高雄榮總婦產部李如悅PreviewObstetricsdeadlytriad:hemorrhage,infection,preeclampsiaIncidence:3.7-5%16%of3201pregnancy-relateddeathsintheUnitedStatesfrom1991-1997GestationalhypertensionBP≧140/90mmHgforfirsttimeduringpregnancyNoproteinuriaBPreturnstonormal<12weeks’postpartumFinaldiagnosismade

2、onlypostpartumMayhaveothersignsorsymptomsofpreeclampsia,forexample,epigastricdiscomfortorthrombocytopeniaTABLE34-1DiagnosisofHypertensiveDisordersComplicatingPregnancyPreeclampsiaMinimumcriteriaBP≧140/90mmHgafter20weeks’gestation,2measurementsaminimumof6hoursapartProteinuria≧300mg/2

3、4hoursor≧1+dipstickoftwourinespecimenscollectedatleast4hoursapartIncreasedcertaintyofpreeclampsiaBP≧160/110mgHgProteinuria2.0g/24hoursor≧2+dipstickSerumcreatinine>1.2mg/dLunlessknowntobepreviouslyelevatedPlatelets<100,000/mm3Microangiopathichemolysis(increasedLDHorschistocytesorhelm

4、etcellsonperipheralbloodsmear)ElevatedALTorASTPersistentheadacheorothercerebralorvisualdisturbancePersistentepigastricpainEclampsiaSeizuresthatcannotbeattributedtoothercausesinawomanwithpreeclampsiaSuperimposedPreeclampsia(onchronichypertension)New-onsetproteinuria≧300mg/24hoursinhy

5、pertensivewomenbutnoproteinuriabefore20weeks’gestationAsuddenincreaseinproteinuriaorbloodpressureorplateletcount<100,000/mm3inwomenwithhypertensionandproteinuriabefore20weeks’gestationChronicHypertensionBP≧140/90mmHgbeforepregnancyordiagnosedbefore20weeks’gestationnotattributabletog

6、estationaltrophoblasticdiseaseorHypertensionfirstdiagnosedafter20weeks’gestationandpersistentafter12weeks’postpartumEtiolotyAbnormaltrophoblasticinvasionInnormalimplantationuterinespiralarteriesundergoextensiveremodelingastheyareinvadedbyendovasculartrophoblastsInpreeclampsiaIncompl

7、etetrophoblasticinvasionDecidualvessels,notmyometrialvessels,becomelinedwithendovasculartrophoblastsImmunologicalfactorsPreeclampsiaisimmunemediated.Themicroscopicchangesatthematernal-placentalinterfacearesuggestiveofacutegraftrejectionAtherosisisdemonstratedinbloodvessels.Thevascul

8、opathyandtheinflamm