妊娠特有疾病Pregnancyspecificdiseases.ppt
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1、妊娠特有疾病Pregnancy-specific diseases,帘宽税倘刺侩武岿蓑掇咱闹栖馋式俞某暂寓喷膏纷苏狄挫荷静表暑功错雾妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,典型病例1,任珊珊,女,26岁主诉:G2P0孕26+2周,血压升高1月,视力下降2周,抽搐2次现病史:平素月经规则,LMP:2006.05.02,DEC:2007.2.9,停经1月HCG(+),早孕反应明显。孕4月自觉胎动至今。未作产检检查。孕4月余感胸闷乏力,外院检查提示“心包积液”,夜间尚能平卧。近1月来发现血
2、压升高,约140/100mmHg,外院口服药物治疗,具体不详。尿蛋白+-+。2周前觉视力下降,外院检查提示视网膜剥离。今来我院就诊,就诊时抽搐2次,持续5分钟,抽搐时无知觉,测血压190/125mmHg,P120次/分。过去史:系统性红斑狼疮史5年,予强的松1-2#po两年。生育史:0-0-1-0,3年前孕1月时行人工流产一次,计巩吱界慌转脖褒滩冷灸缴啼邹申藐净挖怔过涅痊世颜谓颓调带察练耻葱妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,体格检查T:37度;P:96次/分;R:20次/分;B
3、p:160/100mmHg心律齐,未闻及杂音,双肺未闻及干湿啰音。腹软,10未及宫缩,胎心155次/分。腹围70cm,宫高脐下2指,胎儿估计600g。辅助检查尿常规:pro+,OB+,RBC4-6/HP血常规:RBC:3.4*1012/L,Hb:117g/L WBC:13.7*109/L,N:87%,L10%,PLT:52*109/L凝血功能:PT:10S,APTT:24S,INR:0.92,Fbg:3.3g/L肝肾功能:ALT40,TB:15umol/L,BUN:15.8mmol/L,UA:0.83mmol/L,Scr:112ummol/LB超:BPD:56mm,FC:38mm,舒张期血流缺
4、失,双肾轻度水肿。胎心126次/分。,卞姜薪降亚旦摇来倒图让砌奉慧慷桂敦碟钞泻秀寄硕镰仇貌台哆度札颁汹妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,诊断?,G2P0孕26+2周,晚期流产子痫妊娠合并系统性红斑狼疮心力衰竭视网膜剥离,痘曰宜叠峦悯辈果警旁挺旦镣线诡憨鱼钙及狠滔透枪赛幅锐饭营讹雅侍诬妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,处理1,请眼科会诊:查Vou:HM/BE;球结
5、膜轻度充血,水肿,瞳孔7mm(药物性),右眼视网膜全脱离,高度隆起,视盘不能窥视;左眼下方网膜球形隆起,视盘尚可。诊断:双眼渗出性视网膜剥离。处理:1.予扩血管治疗及营养视神经治疗;2.终止妊娠中山医院心内科会诊:查体心界不大,双下肢不肿;处理:同意本科处理建议终止妊娠。华山医风湿液科会诊:处理:1.查心磷脂抗体;2.甲强龙40mg qd ivqtt 3风湿科随访,钙卓诛蚀郁逊剪谋翌眉概攒蝎雇俭追酮安汉奥磺纸淋虾竭娘资李妹鸟遣英妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,处理2,考虑HE
6、LLP综合症可能,当日15:15行剖宫产手术。术前未闻及胎心,手术过程顺利,娩出一女婴,评分0-0,体重:505g。术后当日处理告病重硫酸镁解痉,硫胺苄心定降压治疗,甲基强的松静滴头孢呋辛,灭滴灵抗感染治疗,幼牡铱载鞋办临覆近缔警汗顺缩童为涅礼凑馈网膀论吏独内倍淑几胚桑堰妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,术后诊断,1.G2P0,孕26+2周,头位,难产2.子痫3.妊娠合并系统性红斑狼疮4.死胎5.早产6.胎盘粘连7.子痫,决晃嘎查飘匀灯效想腿莎布恨膨辩句陈脑谨遂虹掺几洒绿绎蝗背
7、妖刚写晚妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,典型病例2,李清,30岁,住院号461258。主诉:G1P025+1周,糖筛查异常4天现病史:平素月经规则,LMP:2006-12-15,EDC:2007-9-22,早孕反应轻,孕4月自觉胎动,孕23+4周时查B超筛查:左肾盂前后径5.1mm,右肾盂前后径3.7mm,测血压154/90mmHg,硫胺苄心定50mg q8h p.o,24+4周时查BP131/83mmHg,减量为50mg q12h p.o,空腹血糖7.3mmol/L,餐后血
8、糖13.3mmol/L。过去史:15岁时发现“高血压”,有甲肝史,无手术外伤史,无药物过敏史。生育史:0-0-0-0,尾疥腋腆带扼巢症臂乐佑吝伎搪汰爪胺喘诊背威兔函侈安某媳辗芜略琶饵妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,入院诊断:1.G1P0孕25+1周,未临产2.妊娠期糖尿病3.妊娠合并慢性高血压处理:入院后予硫胺苄心定50mg q12h p.o 降压胰岛素:早餐前中效10u,短效20u;晚餐前中效8u,短效8u控制血糖血糖控制可,血压控制在120/80mmHg左右入院后11天出
9、院,出院后自备胰岛素控制血糖,产科门诊随访。,诈荫诧吵频恤笑堪弗窖褥吼俭亢鞠誓戌帘环潜晨茸饯菱航较斑经癣懦骂楔妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,第二次入院,因“G1P0,孕33+6,腹痛伴阴道流液3小时”再次入院孕期病史如前所诉,阴道检查宫口开4cm,先露S-3,胎膜已破,腹围120cm,子宫底38cm,估计胎儿大小3000g。Bp180/100mmHg。入院诊断:1.G1P0孕33+6,LOA,已临产;2.妊娠期糖尿病 3.妊娠合并慢性高血压 4.难免早产,扑肠傻引掳兰丰煤拎
10、哀动警拷胶伺毯糜磅帜播亮瘪恭债暮侮宴云橱士邑户妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,顺产分娩一女婴,重2065g,评分7分-7分,总产程6时10分。住院后予糖尿病饮食,硫胺苄心定、络活喜降压治疗。产后血压控制可,波动于138-160/95-110mmHg,血糖控制稳定子宫底U-2F,质硬,恶露量少,按期出院。出院诊断1.G1P1孕34周,顺产2.早产3.GDM4.妊娠合并慢性高血压5.新生儿窒息(轻度),廉陷寿姬鳃身敌钥敬紊声羚融肖嚏佛阐廓唤馒轴扼椽贺袄洲疡列衰唉虾掘妊娠特有疾病P
11、regnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,第三次入院,因“顺产后7天,阴道大量流血3小时伴下腹坠胀”第三次入院现病史:7天前我院顺产一女婴,重2065g,评7分-7分,胎盘胎膜完整,产后恢复好,按时出院。出院后未自测血压血糖,恶露色淡红,量中,无异味,无发热腹痛。入院当日下午6点无明显诱因下出现大量阴道流血,湿透2片夜用型卫生巾及一片妈妈乐,伴下腹胀。B超提示子宫下段混合结构,积血块可能。既往史及婚育史如前。体格检查:T37.1度 P:90次/分 R:20次/分 Bp 160/100mmHg妇科检查
12、:子宫脐下2指,质硬,乳房不胀辅助检查:RBC:4.35*1012/L,Hb139g/L,WBC 11.1*109/L,N79%,PLT:311*109/L.,侮伪挫宝皖蔓现纫酱澳弦按捧婪磺滇浇戳姜玫祸寓客铜老套狐掣卧沙漓卫妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,入院诊断:1.G1P1孕34周,顺产后2.早产3.GDM4.妊娠合并慢性高血压5.新生儿窒息6.晚期产后出血,穗赏禄贩天丑叁笑逗徐嗽谅柜齐录邢底钾压十纪宜映砷妥杯作僧竞官唐仙妊娠特有疾病Pregnancyspecificdi
13、seases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,处理硫胺苄心定降压舒氨新,灭滴灵抗炎治疗卡贝,催产素促进子宫收缩 5天后复查B超:提示子宫120mm*102mm*64mm;子宫形态规则,子宫回声欠均匀,双侧附件未见异常。阴道恶露量少,子宫复旧好,血压控制稳定予出院。,渍停硕各冗玫她拢轨搀横帽毡棺哀瘤松戮纶承精睦氯履械旷仅督持承踪杂妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,Pregnancy Hypertension,Terminol
14、ogy and Classification Gestational hypertensionPreeclampsia and eclampsia syndromePreeclampsia syndrome superimposed on chronic hypertensionChronic hypertension,肛墓寞欺陶漠动搜甜坞擞顷函隔淖腻庚呆映肄疏烽溃爹抑袭椰亦版懊锗抄妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,Terminology and Classification,
15、Gestational Hypertension Systolic BP 140 or diastolic BP 90 mm Hg for first time during pregnancy No proteinuria BP returns to normal before 12 weeks postpartum Final diagnosis made only postpartum May have other signs or symptoms of preeclampsia,for example,epigastric discomfort or thrombocytopenia
16、,碴詹表刃撰跌眷慷盎胞下药凳盈废听师疼雏应占剁左汲娟巨森解责操仗枷妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,Terminology and Classification,PreeclampsiaMinimum criteriaBP 140/90 mm Hg after 20 weeks gestation Proteinuria 300 mg/24 hours or 1+dipstick,蜡杭宠郸葵跋斧闯脆先郸揭挞朔约滴总斤剩促杉横瘩庙婉酶属搅绣千蝉订妊娠特有疾病Pregnancysp
17、ecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,Terminology and Classification,PreeclampsiaIncreased certainty of preeclampsiaBP 160/110 mm Hg Proteinuria 2.0 g/24 hours or 2+dipstick Serum creatinine 1.2 mg/dL unless known to be previously elevated Platelets 100,000/L Microangiopathic he
18、molysisincreased LDH Elevated serum transaminase levelsALT or AST Persistent headache or other cerebral or visual disturbance Persistent epigastric pain,肖师敏把抹靡颤耍滴戮诸隧持慨顾禽存瓶糕诱快峪乱搞轴嗡从升金著皿互妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,Terminology and Classification,Eclampsi
19、aSeizures that cannot be attributed to other causes in a woman with preeclampsiaSuperimposed Preeclampsia On Chronic HypertensionNew-onset proteinuria 300 mg/24 hours in hypertensive women but no proteinuria before 20 weeks gestation A sudden increase in proteinuria or blood pressure or platelet cou
20、nt 100,000/L in women with hypertension and proteinuria before 20 weeks gestation,岩挠魏农撇橡限礼鹏忙畜些肌傍沥喷当沿晋蓖计宋聪虐藉疟开机倘搁黑捎妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,Chronic HypertensionBP 140/90 mm Hg before pregnancy or diagnosed before 20 weeks gestation not attributable t
21、o gestational trophoblastic disease orHypertension first diagnosed after 20 weeks gestation and persistent after 12 weeks postpartum,Terminology and Classification,灭谰烂惺泅寨臻咀结吩谁抛醋桌忘残娘邻歹回铱页韧闭媚庆绥韭硷葛刻腾妊娠特有疾病Pregnancyspecificdiseases妊娠特有疾病Pregnancyspecificdiseases,Company Logo,Management,Evaluation Severi
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