comorbid diseases in pregnancy课件

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1、ComorbidDiseasesinPregnancyChapter105TintinalliPresentedbyDr.KelleyDecember6,2005Diabetes2-3%ofallpregnanciesGestational-90%A1-dietcontrolledA2-insulincontrolledPredatedDiabetes-10%Alwaysinsulindependent.DoNOTuseoralhypoglycemics!!!Goals-<90mg/dLfasting<1401ºpostprandial

2、insulinneedsaspregnancyprogresses.DiabetesComplicationsHypertensivediseases,pretermlabor,spontaneousAb,pyelonephritis,DKA,hypoglycemiaDKA-Rapidoccurrenceatlowerglucoselevels.SametxasnonpregnantDiabetesComplicationsCont.Hypoglycemia45%occurrenceSymptoms:swelling,tremors,

3、blurredvision,diplopia,weakness,hunger,confusion,paresthesias,anxiety,palpitations,vomiting,HA,stuporTx:Levels<70mg/dL&abletotalkandfollowcommands-1cupmilkwithbreadandcrackersq15min.Severe-1ampD50WIVPorglucagon1-2mgIM/SQwithorwithoutD5WIV@50-100cc/hr.HyperthyroidismAssoc

4、iatedwithriskofpreeclampsia,neonatalmorbidity,lowbirthweight,andpossiblecongenitalmalformations.Symptoms:nervousness,palpitations,heatintolerance,inabilitytogainweight(Thyrotoxicosismaypresentashyperemesisgravidarum.)Tx:PTU(100-150mgPOTID)ThyroidStormSymptoms:fever,volu

5、medepletion,cardiacdecompensationMortalityrateof25%Tx:IVF,Oxygen,antipyreticagents,PTU400mgPOq8º,sodiumiodide1gin500mLIVFqday,propranolol40mgPOq6º(unlesscardiacfailure),coolingblanket.NOradioactiveiodinetherapy(congenitalhypothyroidism)!HypertensionDividedintochronicorpr

6、eeclampsia,howeverchronicHTNcanleadtopreeclampsia.Chronic4-5%occurrenceBP>140/90mmHgbefore12thweekgest.Tx(indicatedwhensystolic>160ordiastolic>100):Aldomet,Labetalol,nifedipineAcuteHypertensiveCrisisIVLabetalol(10mgq5-10minupto300mgtotal)orHydralazine(5-10mgq15minIV)Goa

7、l:140-150/90-100DysrhytmiasRareLidocaine,digoxin,procainamidecanbeusedasindicated.Maintenancebeta-blockersarecategoryCsoprescribewithconsultationwithcardiologist/obstetrician.VerapamileffectiveforcardioversionofSVTtoNSRwithoutadverseeffects.AnticoagulationforA.Fib-unfrac

8、tionatedorLMWHCardioversionsafeforfetusArtificialpacemakernotshowntoaffectpregnancycourse.Thromboemboli