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Pregnancy-induced hypertension syndrome (PIH)

Pregnancy-induced hypertension syndrome (PIH). 妊娠高血压综合征. pathogenesis. The factors of PIH

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Pregnancy-induced hypertension syndrome (PIH)

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  1. Pregnancy-induced hypertensionsyndrome (PIH) 妊娠高血压综合征

  2. pathogenesis • The factors of PIH • the theories of pathogenesis A utero-placental ischemia theory B Neuro-endocrine theory C immunological theory(ABO;HLA) D DIC theory E others : endothelin(ET--内皮素） calcium shorting

  3. Pathophysiologic changes Widespread arteriolar spasm three main symptoms: hypertension proteinuria edema

  4. Pathologic changes in main organs ① • Brain : localized and spot hemorrhage （局灶性，点状出血） thrombosis（栓塞） softening （软化） • heart : fibrin thrombi （纤维栓塞） focal necrosis （灶性坏死）

  5. Pathologic changes in main organs ② • Liver : periportal hemorrhagic necrosis （门脉周围出血坏死） • kidneys : • placenta : atherosclerosis IUGR--intrauterine growth retardation (宫内发育迟缓）

  6. Classification of PIH syndrome

  7. unclassification • Edema : edema spreading to the thighs or above • proteinueia : (+) or more • chronic hypertension

  8. Clinical findings • Mild PIH syndrome • moderate PIH syndrome • severe PIH syndrome prepartal eclampsia （产前子痫） partal eclampsia （ 产时子痫） postpartal eclampsia （产后子痫）

  9. diagnosis • History hypertension proteinuria • sign edema symptom convulsion , coma blood examination • assistant liver and renal functions examination funduscopy of eyes others

  10. Differential diagnosis • Essential hypertension and chronic nephritis • convulsive disorders

  11. Influence on mother and fetus • On mother : HELLP syndrome hemolysis（ 溶血） elevated liver enzymes（肝酶升高） lowplatelet count（血小板减少） • On fetus :

  12. Prevention • The prenatal care in time • adequate nutrition and rest • the predetective diagnosis : mean arterial blood pressure roll over test blood variation calcium amount in urine

  13. Management • Mild cases A rest B diet C medication : phnobarbital （苯巴比妥） diazepam（安定）

  14. Moderate and severe cases  • A antiseptic medicine magnesium sulfate（硫酸镁） • B sedative drugs hibernation mixture I（冬眠1号） diazepam • C antihypertensive drugs • D expansive volume treatment albumin （白蛋白） plasma （血浆） whole blood（全血）

  15. Moderate and severe cases  • E Diuretics:furosemide（速尿） 20%mannitol（甘露醇） • F Termination of pregnancy a indications : b methods :induction of labor （引产） cesarean section（剖宫产） • G The management of eclampsia a controlling convulsion b nursing c closely monitoring

  16. 病 例 张平，女，36岁，以“停经九个月，胎动五个月，双下肢浮肿两周，头晕眼花一小时。”为主诉入院。早孕反应及胎动如期出现，两周前无明显诱因双下肢浮肿，休息后无好转。一小时前出现头晕眼花。既往无高血压，慢性肾炎病史。 查体：T36.7℃，P78次/分，BP175/110mmHg, 心肺听诊无异常，腹膨隆，足月腹型，LOA，浮肿+++。 实验室检查：血常规示PL258G/L，HGB108g / L，HCT0.45。尿常规示蛋白+++。 辅助检查：B超示BPD9.0cm，FL7.2cm，胎盘钙化Ⅱ级。NST有反应型。

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