妊娠期高血压

Clinical Findings
2. Laboratory Findings Hemoconcentration: hemoglobin↑ hematocrit ↑ Thrombocytopenia ,Anemia DIC: coagulation factors↓ and Fibrin split products ↑ Uric acid ≥ 6mg/dL Urinalysis: proteinuria, hyaline casts Renal function: Serum creatinine ↑ Liver function: ALT ↑Albumin ↓ LDH↑
Definitions

Gestational hypertension(Transient hypertension): Hypertension is defined as a systolic blood pressure level of 140mm Hg or higher or a diastolic blood pressure level of 90 mm Hg or higher that occurs after 20 weeks of gestation in a woman with previously normal blood pressure and with normalization of blood pressure postpartum[12 weeks].. As many as one quarter of women with gestational hypertension will develop proteinuria, ie, preeclampsia.
Definitions


Preeclampsia: A syndrome defined by hypertension and proteinuria that also may be associated with myriad other signs and symptoms, such as edema, visual disturbances, headache,laboratory abnormalities… most of all they occur after 20 weeks gestation, rare some special cases can occurring before 20 weeks gestation. Ep. Hydatidiform mole. Eclampsia: The occurrence of seizures that can not be attributed to other causes in a preeclampsia patient
பைடு நூலகம்
production of substances in the blood
endothelial cells injury
unbalance of important substances
nitric oxide,endothelin1, prostacyclin, thrombocane A tissue plasminogen activator intravascular coagulation generalized vasoconstriction capillary leak
What is hypertensive state
It includes: gestational hypertension. preeclampsia-eclampsia☆ chronic hypertension chronic hypertension with superimposed preeclampsia
hemoconcentration
Reduced perfusion to many (all?) organs *Present before clinical disease
Pathological Changes
■Brain: Celebral ischemia and Edema, Petechial hemorrhage ■Liver: Hemorrhage and Necrosis ■Heart: Subendocardial Necrosis ■Kidney: Glomerular Endotheliosis, Acute Tubular Necrosis ■ Pulmonary System：Pulmonary Edema ■ Eyes： Retinal Vasospasm, Retinal edema Retinal Detachment and Cortical Blindness




Headache, Convulsion. Blurred Vision, Hcotomata, Hyperreflexia, Eclampsia Hepatic Disfunction , Upper Abdominal Pain Techcardia ,Heart Failure Oliguria, Renal Disfunction Pulmonary Edema Intrauterine Growth Restriction Abruption Placentae Ascites and Anasarca ……

aggravation of disease
Gestational hypertension
Chronic hypertension
mild Preeclampsia
Chronic hypertension with Superimposed preeclampsiaeclampsia
Severe Preeclampsia
Pathogenesis
The pathogenesis is unclear relatively new theory: endothelial cell injury
Theory of endothelial cell injury
Abnormal placental implantation reduced placental perfusion
Eclampsia Delivery Delivery
Case Study


You have been seeing a 23-year-old woman, gravida 1,para 0,at 31 weeks of gestation, throughout her pregnancy. She has no known medical history. She denies blurry vision, epigastric or right upper quadrant pain, severe headache, or trouble breathing, Her blood pressure and urine protein dipstick results for past three visits are as follows:visit 1,BP=105/60,Udip=0;visit2,BP=130/90,Udip=1+; visit3,BP=140/95,Udip=1+. Today her BP=160/95 and Udip=3+. She reports lots of fetal movement. Lungs are clear auscultation bilaterally. The most accurate diagnosis for this patient is:
Pathophysiological Changes
Vasoconstriction * blood pressure↑
intravascular coagulation * perfusion↓
organs
capillary leak * (Loss of fluid from intravascular space ) edema ,
Definitions
Chronic hypertension: Blood pressure exceeding 140/90 mm Hg before conception or before 20 weeks' gestation or that persists for more than 12 weeks postpartum. Chronic hypertension with Superimposed preeclampsia: Preeclampsia occur in pregnant women with chronic hypertension.
Pathological Changes
Blood: Hemoconcentration Thrombocytopenia Microangiopathic Hemolytic Anemia DIC HELLP syndrome ■ Placenta: Vascular resistance in the spiral artery Acute atherosis
■
Clinical Findings
1.Symptoms and Signs: A.Hypertension B.Proteinuria C.Edema D.Differing clinical picture --- multisystem disease
Differing clinical picture --multisystem disease
Hypertensive States of Pregnancy
he xiaohong women’s hospital school of medicine zhejiang university