高血压英文ppt精品课件hypertensive disorders in _2

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1、HYPERTENSIVEDISORDERSINPREGNANCYDR.SALWANEYAZIASSISSTANTPROFKSU/CONSULTANTOBGYNPEDIATRIC&ADOLESCENTGYNECOLOGISTTYPESOFHYPERTENSIVEDISEASEINPREGNANCY1-Gestationalhypertension2-PET3-Eclampsia4-Chronichypertension5-PETsuperimposedonchronichypertension1-GestationalhypertensionBP≥140/90mmHgforthefirstt

2、imeduringpregnancyNoproteinuriaBPreturnstoN<12WkpostpartumFinalDxmadeonlypostpartumMayhaveothersignsofPETeg.Headache,epigastricdiscomfortorthrombocytopeniaPETMinimumcriteriaBP≥140/90mmHgafter20WkgestationProteinuria≥300mg/24hrsor≥1+dipstickIncreasedcertaintyofPETBP≥160/110mmHgProteinuria≥2gm/24hrs

3、or≥2+dipstickSerumcreatinine>1.2mg/dlunlessknowntobepreviouslyelevatedPlatelets<100000/mm³IncreasedcertaintyofPETMicroangiopathichemolysis(increasedLDH)ElevatedALTorASTPersistantheadacheorothercerebral/visualdisturbancePersistantepigastricpainECLAMPSIASeizuresthatcannotbeattributedtoothercausesina

4、womanwithPET.1%ofPtwithPETdevelopECCHRONICHYPERTENSIONBP≥140/90mmHgbeforepregnancyorDxbefore20WkgestationHPTfirstDxafter20Wkgestation&persistantafter12WkpostpartumPETSUPERIMPOSEDONCHRONICHYPERTENSIONNewonsetproteinuria≥300mg/24hrsinhypertensivewomenbutnoproteinuriabefore20WkgestationAsuddenincreas

5、einproteinuriaorBPorPltcount<100000/mm³inwomenwithHPT&proteinuriabefore20WkgestationINCIDENCE&RISKFACTORSPEToccursin6-8%ofalllivebirthRISKFACTORSExtremesofreproductiveage15<&>35YNulliparityBlackraceHxofPETina1stdegreefemalerelativeHxofPETinpriorpregnancyDMChronicrenaldiseaseChHPTMultiplepregnancy

6、twins13vs6%HydatidiformmoleNonimmunehydropsfetalisObesity4.3%BMI<19.8kg/m²13.3%BMI≥35kg/m²Smoking↓riskofHPTPATHOGENESISEndothelialcellinjury↓↓prostacyclin&↑thromboxaneA2Rejectionphenomenon(inadequatematenalAbresponse)CompromisedplacentalperfusionAlteredvascularreactivity↑sensitivitytovaspre

7、ssinEPN,NEPN&angiotensin↓GFRwithretentionofsalt&water↓intravascularvolume↑CNSirritabilityDICUterinemusclestretch&ischemiaDietaryfactorsGeneticfactorsPATHOGENESISSummaryofcurrenthypothesis:Immunologicaldisturbance