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1、Hypertension Disorders Complicating Pregnancy,妊娠期高血压疾病,Hypertensive Disorders complicating Pregnancy,Gestational Hypertension,Preeclampsia,Preeclampsia Superimposed on Chronic Hypertension,Chronic Hypertension,Eclampsia,A Group of Related Diseases,Characteristics,Systemic small arteries spasm,Endoth
2、elial cell injury,Hypertension,Proteinuria,Multiple organs dysfunction,Convulsion,Maternal mortality,Fetal mortality,Gestational Hypertension; Chronic hypertension,Eclampsia,Preeclampsia; Preeclampsia Superimposed on Chronic Hypertension,Hypertension disorders complicating pregnancy,Pathophysiology
3、Category and clinical manifestation Diagnosis and differential diagnosis Management and prevention,病理生理,临床表现,诊断,治疗,Epidemiology,Incidence： 6-9% Preeclampsia-eclampsia： 70% Chronic Hypertension ： 30% Eclampsia 0.5% - 1% China 1.0% Overseas 0.5% Reflection of medical level The second cause of maternal
4、 death (20%) Cause of premature delivery（10%） Unknown origin,Pathophysiology,Basic pathological changes Spasm of systemic small arteries Vascular endothelial cell injury,Pathophysiology,fluid,protein,Hypertension Edema Proteinuria Hemoconcentration,Small arterial spasm,Endothelial cell injury,Multip
5、le organs dysfunction,Ischemia Edema malfunction,Systemic Disease,Brain,Hydrocephalus Hyperemia/ischemia Thrombosis cerebral hemorrhage cerebral hernia,headache dazzle nausea vomit,Hypopsia retinal detachment Cortical blindness Dysesthesia Confusion of thinking,Eclampsia convulsion coma,brain： Vasos
6、pasm permeability,kidney,renal vasospasm,renal blood flow ,glomerular filtration rate ,pathology ： Glomerular expansion swollen vascular endothelial cell cellulose deposition renocortical necrosisrenal irreversible damage,clinical manifestation ： albuminuria hypoproteinemia renal dysfunction creatin
7、ine urea nitrogen uric acid oliguria renal failure,liver,hepatic vasospasm; hepatic ischemia; hepatic edema,liver enlargement; hepatic dysfunction elevated liver enzyme jaundice hypoproteinemia coagulation function changed,severe： Periportal necrosis hepatic subcapsularhematoma hepatorrhexis,HELLP s
8、ymdrome: Elevated hepatic enzymes Decreased blood platelet,Cardiovascular System,Blood Pressure ,Vasospasm,Vascular Resistance ,Cardiac Load ,heart failure,vasospasm,Myocardial Ischemia Interstitial Edema Spotty Necrosis,pulmonary vasospasm,Pulmonary Hypertension,Pulmonary Edema,Oliguria,water-sodiu
9、m retention,Relative Blood Volume Excess,Iatrogenic Blood Volume Excess,High burden,Poor ability,blood system,Relative hypovolemia Anemia Decreased blood platelet Hypercoagulability blood clotting factor,placenta-fetus,placenta Placental hypoperfusion Spiral arteries sclerosis Placental Infarction P
10、lacental Abruption Placental function decreases,fetus IUGR fetal distress oligohydramnios fetal death,Pathophysiology,Brain Headache; visual blurred; coma; hernia Kidney Renal function compromised; proteinuria; renal failure Liver Persistent upper right abdominal pain; Elevated enzyme; jaundice; hem
11、atoma; rupture,Systematic disease,Pathophysiology,Cardiovascular system Low output- high resistance; myocardial ischemia; pulmonary hypertension; edema; heart failure Blood Low volume; hypercoagulability; DIC,Pathophysiology,Uterus and Placenta Low perfusion; placental atherosclerosis Placental infa
12、rction; placental abruption; fetal growth retardation; fetal death,High risk factors,Primipara 40y Multiple pregnancy Hypertension Chronic nephritis Malnutrition Poor social status Diabetes,Anti-phospholipid syndrome Angiotensin gene T235 (+),Etiology,Genetic susceptibility hypothesis Immune maladap
13、tation hypothesis Placental ischemia hypothesis Oxidative stress hypothesis,Genetic susceptibility,Immune maladaptation,Placental ischemia,Oxidative stress,Abnormal placental,The change of cytokine,PE,development,Endothelium injured,DIC,Complications,Genetic susceptibility hypothesis,Hypertension,Im
14、mune maladaptation hypothesis,Multiple gestation Abortion and blood transfusion Ovum and sperm donation,Placental ischemia hypothesis,40% total spiral artery area compared to normal pregnancyEndothelial cell injury,Oxidative stress hypothesis,Oxidative stress reaction,Endothelial cell injury,Categor
15、y and clinical manifestation,Gestational hypertension Preeclampsia Eclampsia Chronic hypertension Preeclampsia superimposed on chronic hypertension,clinical features,typical : hypertension、albuminuria、edema untypical ： asymptomatic severe： nausea、vomit headache、dazzle convulsion 、coma chest distress
16、 、palpitation,Gestational Hypertension,Definition Hypertension occurs 20 weeks after gestation and recovers 12 weeks postpartum SBP=140mmHg DBP =90mmHg Diagnosed only after delivery,Preeclampsia,Hypertention occurs 20 weeks after gestation BP=140/90mmHg Proteinuria Proteinuria 300mg/24h Urine protein （+） Other symptoms Headache, visual blurring Upper abdominal pain,
