B Medical Complications of Pregnancy妊娠内科合并症知识讲稿教程文件.ppt

Consider anti-coagulation therapy考虑抗凝 Impedance plethysmography阻抗容积描记术 Ultrasound超声 Meets diagnostic criteria for DVT符合诊断标准 Equivocal不确定 Begin anti-coagulation therapy开始抗凝治疗 Repeat ultrasound vs. IPG vs. abdominal shielded venography重复检查或腹部遮盖的静脉造影 Meets diagnostic criteria for DVT符合诊断标准 Begin anti-coagulation therapy开始抗凝治疗 Equivocal不确定 DVT Diagnosis Pulmonary Embolism (PE)肺栓塞 Majority occur postpartum2/3发生于产后 Mild dyspnea and tachycardia progressing to cardiopulmonary collapse表现各异；从轻度的呼吸困难及心动过速到心肺虚脱 Treat (O2, hemodynamic support) and evaluate simultaneously治疗（吸氧、血液动力学的支持、复苏（ABC’S）及评估同时进行 ABG will show decreased PO2 (85 mm Hg) and increased A-a gradient 血气显示氧分压下降A-a阶梯增大 * Medical Complications of Pregnancy妊娠期合并症 Objectives目 的 Describe selected medical emergencies exclusive to pregnancy描述仅在妊娠出现的医疗急症 Describe selected medical conditions that can cause serious complications in pregnancy描述可能危及生命的妊娠合并症 Formulate a plan for diagnosis and treatment of these conditions制定诊断及治疗的计划 Conditions Exclusive to Pregnancy仅在妊娠出现的症状 Severe pre-eclampsia严重子痫前期 Eclampsia子痫 HELLP syndromeHELLP综合征 Acute fatty liver of pregnancy (AFLP)妊娠期急性脂肪肝 Conditions That Complicate Pregnancy使妊娠复杂化的症状 Deep venous thrombosis (DVT)深静脉血栓 Pulmonary embolism (PE)肺栓塞 Disseminated intravascular coagulation (DIC)弥漫性血管内凝血 Human immunodeficiency virus (HIV) infection HIV感染 Hypertensive Disorders of Pregnancy妊娠相关高血压症 Pregnancy Induced Hypertension妊高症 PIH无蛋白尿 (no proteinuria) HELLP Syndrome HELLP综合征 Chronic Hypertension (Elevated BP prior to 20 weeks)慢性高血压（妊娠前20周血压升高） 6-8% of all gestations妊娠的6-8% Preeclampsia 子痫前期(proteinuria +/- edema)蛋白尿水肿 Eclampsia 子痫 Severe Preeclampsia 严重子痫前期 Pre-Eclampsia子痫前期 Classic Triad:经典三联征 Hypertension (140/90)高血压 Proteinuria (1+ or 300 mg/24h)蛋白尿 Generalized edema (least reliable)广泛性水肿 Hypertension and proteinuria must be present on two occasions 6 hr apart高血压和蛋白尿需在至少间隔6小时、二次以上 Rapid weight gain is supportive evidence 体重迅速增加支持诊断 Diagnostic Criteria for Severe Preeclampsia