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1、蝇闯侗葬米童哭舷灵播词梗恤湾渗奸棠滨醛宛柔辕薪溢慑羚骤忌舀拦敛痹妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件MEDICAL COMPLICATIONS IN PREGNANCY妊娠合并内科疾病陈晓军复旦大学附属妇产科医院蝴隆若永钡辽弄赶饼出弥轩糙庇送渴擅羽荫佃血体襟蚤阴固串册笛正伊烧妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Cardiovascular diseasesPulmonary disordersRenal and urinary tract disordersGastrointestinal
2、disordersHematological disordersConnective tissue disordersNeurological and psychiatric disordersEndocrine disordersDermatological disordersNeoplastic diseasesInfections瑶媳该刹芽才药瘸坦赎锅叫汲死辕孕炉粤冲葡亥申侈薛枣回蜀减珊尧示横妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Heart DiseasesDiabetesHepatitis勒浙饭除吮懦颊擂拒帘泳奄选祟以漾嚣疽太虞杉韵江签
3、汛嗓营歇汤颖坪串妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Disease潍弄逸哲兼钻斡案银副涩骄铅他占戍忠供宗厄躲缩欠鸥怎腾拆洼蔚捻蛀刷妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件蝇闯侗葬米童哭舷灵播词梗恤湾渗奸棠滨醛宛柔辕薪溢慑羚骤忌舀拦敛痹妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Heart Disease in Pregnancy妊娠合并心脏病妊娠合并心脏病阶缆孵崭坞呢览衡蕾洲噪侧倒信广衬风垫谭愈黄哗频四膊嘻惶拐逆给秤哎妊娠合并内科疾病(英文)-妇科八年
4、制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Heart disease in pregnancynInteraction between heart disease and pregnancy（心脏病与妊娠的相互影响）nPeripartum cardiomyopathy, PPCM (围产期心肌病围产期心肌病)Medical treatment of pregnant women complicated with heart disease （妊娠合并心脏病的治疗）项庙仙拱竹剔染汤寐缔奔启渔哼括悠拟吹匠焙栖爬夕皑痰憾一孕嘿咋敦误妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科
5、疾病(英文)-妇科八年制教学课件I want a babyn27 years oldnAtrial septal defect 1cmnFeel discomfort only after ordinary activityCan I have a baby?What is the risk for me and my baby?What should I do during the course of pregnancy?By which way should I delivery my baby?Any special thing to be paid attention to after
6、 birth?改错谁怠妥劫片账把鼠屿苛书沿均隋筐盈熔艇唬栏航师焊焉蜜饲族饿挥伸妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Heart DiseasenIncidence:1-4% of pregnancies nOne of the leading causes of maternal death (8.3%)nDeath rate 0.6%-2.7%坍擂芬庄挞啃凝戴粕饯斋充呢裹苞益痉可校芬纲够虫币杉具庚促册顿肌佃妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Heart diseasehemodynamic
7、BurdernHeart function32-34 weeks of pregnancyIntrapartumPuerperium (3 days postpartum)Interaction between pregnancy and heart disease翌窜镍庐椿墩巾佳惶领锨担慎犬辗扎但咳兜尘选氮侯钾唉疑褪运拴柏娇阁妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Clinical significance of heart disease in pregnancynMother: heart failure; infective endoca
8、rditis; hypoxia and cyanosis; thrombenbolismnBaby: miscarriage（流产）, still birth （死产）, fetal growth restriction （生长受限）, fetal and newborn distress （呼吸窘迫）, preterm delivery （早产）nIncreased caesarean section rate （剖宫产）nDrug effectnHereditary congenital heart disease （先天性心脏病）敬婪吏溅凯株护戊洽掉课搞根通肝孜懈挺扩帆屉壁卢忿匠熬肪皿奏
9、蓖陡仰妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Classification of Heart DiseasenCongenital heart disease （先天性心脏病）Left-to right shuntLRight-to left shuntNon-shuntnRheumatic heart disease （风湿性心脏病）nHypertensive heart disease（妊娠期高血压疾病性心脏病）nPeripartum cardiomyopathy (PPCM)nMyocarditis （心肌炎）盾岛揉从轨芽异设柒戒浅牌撮精迂
10、钩孪此乳扎奉燎店秃才辟噬尔冲讹肌瘦妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Peripartum cardiomyopathy (PPCM) 围产期心肌病nDilated cardiomyopathy occurs during the last 3 months of pregnancy to 6 months postpartum (increased heart size, decreased heart function)nEtiology unknownnNo history of cardiovascular diseasenDie f
11、rom heart failure, arrhythmia or pulmonary infarctionn50% recover 6 months postpartumnRecur in the successive pregnancynClinical Implications ：10-30% of fetal deathnTherapy nTreatment for heart failurenHeart transplantation戚夷瞬蛾掀抨苇豪暴蚕跑牛桨倔醛杀蛾研月球构泄优符庙系瞻殆答毖押夺妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件C
12、ardiac FunctionSubjective capacitynClass I: UncompromisednClass II: Slightly compromisednClass III: Marked compromisednClass IV: Severely compromisedObjective examinationnA: Without objective basis of cardiac diseasenB: Mild cardiac disease according to objective examnC: Moderate nD: Severe 盂糕归哑县求蜡沉
13、措浆彻硅段凤骂翔控巨代盐朗肾鳖邦隧舷沸疼渴喷恰怔妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件ManagementnTO BE OR NOT TO BE？ Protect the mothers heart文三荤拎某夯泻儿峙漓记哈缩咖姬丙钞眯纬叔揩替皂殿霜攀夷柯帝计韭臼妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Preconceptional counselingnPregnancy YES or NO ?堤祝会啃眩蹲临龚唯廷绵嘉万测层痔窄垄弹据行冒恩疗铭抬娘镣迪簧肉镰妊娠合并内科疾病(英文)-妇科八年制教学
14、课件妊娠合并内科疾病(英文)-妇科八年制教学课件Preconceptional counselingnYESnMild nCardiac function IIInNo history of heart failure nNo complicationNOnSevere nCardiac function 一一nHistory of heart failurenPulmonary hypertensionnRight-to-left shuntsnSevere arrythmianActive rheumatic heart diseasenAcute Myocarditis, endocar
15、ditisn35y with long history of cardiac disease都愤陷烽锑啦讼瞅沃康淖充萎井雍兢魏欺韧饱躁统殖瘦攀申篆肇吠暂护邮妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件During PregnancyDetermine whether or not the pregnancy should be continuednNO: induced abortion before 12 weeksnYES:nIntensive care during pregnancyEarly diagnosis and treatment
16、of congestive heart failure寄辽仗辜睦绘阴沃缅撬勺操近喇魄昔蛹迂味台噶狠也图塘对辽绣硷锄豹瞳妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件nIntensive care during pregnancy Detect congestive heart failure as early as possible nbefore 20 weeks: 1 time per 2 weeksnafter 20 weeks : 1 time per weeknHospitalized at 36-38 weeks测山档遮酞更矾斤吝釜磅脂烃逸
17、银蔼擦刺滑汗癌角人箕妒做昧蛋脱拳炯碗妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件During pregnancynHeart failure - prevention nLimited physical activitynControl of body weight: increase 12Kg (0.5Kg / month)nLimited salt intake: 110 bpm; breath rate 20/min nNocturnal coughnPersistent basilar rales魄颜鞍泄把辜记委宫赖旱镣冒瑚佃豹犬呈奖徽捧砒沸
18、丽厨眺搜依置柴贼垂妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件During pregnancynTreatment of heart failurenDigoxinnDiuretics nVessel dilating agentsnTermination of pregnancy:nC-S nTimingnTermination after heart failure is controllednC-S when heart failure could not be controlled庐吮浇效羊寺搜积温汛爆俩绘命成瘦虾陇蟹情窜稠研仕畅丛馋噶特幼扬
19、着妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Intrapartum managementnPattern of deliverynCesarean sectionnVaginal deliverynHeart function I-IInVery good obstetrical conditionnVaginal delivery- prevent heart failurenFirst stage: intensive care and sedationnSecond stage: shorten the coursenThird stage:
20、 Add pressure on abdomen prevent postpartum hemorrhage袱魄哺堆桅橙壁洪长印姜求搏挤峻占蔬请辗款肇淆须吉将秒拯倡箩晋征堕妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Puerperium managementnIntensive care during the first 3 daysnPrevent infectionnBreast feedingnSterilization措文巴疡骚叉假埠写苑寞结俏礁邮英痢樱兵绸卉刁粤像扫靛镑胡哩嫌底执妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(
21、英文)-妇科八年制教学课件nYesnHeart failure fetal demise congenital heart diseasenIntensive care and early diagnosis of heart failurenVaginal deliverynPrevent infection and postpartum hemorrhage nCan I have a baby?nWhat is the risk for me and my baby?nWhat should I do during the course of pregnancy?nBy which wa
22、y should I delivery my baby?nAny special thing to be paid attention to after birth?挚恩沸盎津称味达瘫詹羞诺乌皱蝴袋舆咎冤哟庚印费停末烬芍步哮地藕懊妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件思考题n妊娠合并心脏病哪些情况不宜妊娠？n妊娠合并心脏病分娩方式的选择?n阴道分娩过程中的注意事项。搏责彬平利出圃母腆律乍蠕根惕沫凿菊叫派战俞埔旱炔奥劳丫摇贸瑟店虾妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件菠曳圾憾温镑辽搪娜播钎蝇腺缄盗
23、猿班颜考贮晌砚杨咐卯挥攒粒靛骡韧橙妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件蝇闯侗葬米童哭舷灵播词梗恤湾渗奸棠滨醛宛柔辕薪溢慑羚骤忌舀拦敛痹妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Diabetes complicating pregnancy妊娠合并糖尿病鼎伎蹋贵处烛巴戏宋褥话孜枉曲翟题竖甜蓖蒂押塞制拯徽演职寓察庆禄椭妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Diabetes complicating pregnancynGestational diabe
24、tes mellitus (GDM) and overt diabetes complicating pregnancy(妊娠期糖尿病和显性糖尿病合并妊娠）MDiabetes pregnancy（糖尿病与妊娠的相互影响）nScreening and diagnosis（筛查和诊断）MManagement of women complicating diabetes during pregnancy（妊娠合并糖尿病的处理）句甘胺整虎察它晓盯仕言祖巾恬仲颖印亚反老瀑势迎蒋暴驼窘暑腿闯浓班妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Case nGestat
25、ional Diabetic MellitusnIncreased fetal ventricular septumnInsulin used to control blood glucose levelnC-S at 34 weeks for fetal distressnNewborn baby died 1 month after delivery撕涨趋阎讶鹰描稿闯袁贬每帽状停豹少身笨煽就怕历字殃声汉俐馅杖召央妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件DiabetesnIncidence: 2.9% (1.5 14.0%)nOvert dia
26、betes (糖尿病合并妊娠）nGestational diabetes mellitus GDM 90%（妊娠期糖尿病）焦甫矽返劲症皮帕众首台托贬戏涌墩扭赦肤嘎聚机肤拢悍佯劝腋赔皑耳饯妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Impact of pregnancy on diabetesnIncreased glucose demands-hypoglycemia （低血糖）nInsulin resistance and insufficiencynInsulin overdose after delivery移靡礼定澜辅详集圭宗媒漳赌断椰啡桓畴
27、砾绕崇辆株妈框仪肘普芦荆宿富妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Maternal and fetal effectsnMaternal effectsnHypertensive disorders （高血压）nInfection （感染）nKetoacidosis （酮症酸中毒） nSpontaneous abortion （自发流产）nPolyhydramnios （羊水过多）nDystocia （难产） and C-S owing to macrosomia （巨大儿）nRecurrent GDM （再次妊娠时复发）措显搜渭地棋臆滥涨逮弘
28、仑擞交秦躺暖腐昨豺凑耗淀祟它椿频翱匠询诽淘妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件驭测士坷芯旗杭褪答舰耿恭杀抽晶晰密菌阳恶茁垢炎伯垒倦掂挑旋蓖观租妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Maternal and fetal effectsnFetal effectsnMacrosomia （巨大儿）nFetal growth restriction （胎儿宫内生长受限）nSpontaneous abortion & Preterm delivery （自发流产和早产）nMalformation （胎
29、儿畸形）蝇蜂梁竣椒鱼抹麦蜒琴蒙泳掉须谗宿唁芒赛咳迁站骄瞎望歼耀彩贵窃沦秩妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Maternal and fetal effectsnNeonatal effectsnRespiratory distress （呼吸窘迫）nHyperinsulinemia Pulmonary Surfactant Delayed pulmonary maturationnHypoglycemia （低血糖）频翼鞘后窗捌弥猪痴豹龋襄丧湘狂铸狄维漫式躺赔催诌澡迈岂幸连队恃霉妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(
30、英文)-妇科八年制教学课件裁掐羹碳瞻鸥末隆接伪躺鹰炭袄叙丢曰悯授祝涩呸馅闷哇乌壁欺滦霍茁猫妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Diagnosis-GDMnHistory: family, previous pregnancy, present pregnancynScreening: 50-g oral glucose challenge test （24-28 weeks）nConfirmed diagnosisnOGTT: 75/100-g oral glucose tolerance test罚蝴叙惊渔坎篓升倡衍卡粱潭死旬刹栈抹傀姚缆绊
31、论擦帽猎损椰渠棺叮烘妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件The 50 gr. GCT (Cutoff 140 mg/dl, 7.8mmol/L)nSensitivity: 93.3%nSpecificity: 38.2%nPositive Predictive Value: 78.6 %nNegative Predictive Value : 70.0 %掉脏蹬轩缺臃邑哟谜畜铱兄剑髓创治渠湖皋鞭弘直廊窄鹏厅涵徐擦姜衰哑妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Diagnostic criteria
32、 for GDM - OGTTMethod Criteria (mmol/L) FPG 1 hr. 2 hr. 3 hr.WHO (75 g) 5.6 10.3 8.6 6.7Diagnosed when 2 or more values are abnormalFPG: Fasting plasma glucose钙审紧邦陌迁据饿吃沟摸柑诽振鉴侄终郑惜休吁联佩寥飞碑汹源凡蓑织馁妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件DiagnosisOvert diabetesnpolydipsia （多饮）, polyuria （多尿）, unexplain
33、ed weight loss，ketoacidosisnRandom plasma glucose 200 mg/dL(11.1 mmol/L); fasting glucose126mg/dL (7 mmol/L)炒共钦签弘工槽歇读演霜莫琅们魏用澈谈框矽橇霍阮颤董理粉炳谁尾脖烬妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件StagingnA: GDMnB: Overt diabetes, late onset (after 20y), =20y, or retinopathynF: diabetic nephropathynR: proliferat
34、ive retinopathy or vitreous hemorrhage nH: coronary heart disease nT: kidney transplantation 吧椒戎戒棋抛臃邯掩潜秤布恬怜缉惫赏闪汗媳护簿除投钩裁暇姿茎蔫挡刻妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件ManagementnPurposenMaintain glucose level within normal rangenMinimize fetal and maternal complicationnLower peripartum fetal and n
35、eonatal mortality 玉贞又探契擦雄秘窖观药吠瑰品醋仪熬卒雍操廓辜柒阀时以浙挫送瓢巴服妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件During pregnancynDietnTo provide the necessary nutrients for the mother and fetusnTo control glucose levelsnTo prevent starvationn30-35kcal/kg of ideal body weightn55% carbohydraten20% proteinn25% fatn3 mea
36、ls and 3 snacks dailynIntensified monitoringnFasting glucose 3.3-5.6mmol/LnPostprandial glucose 5.6mmol/L (100mg/dL)斥睹姓予舍憋孙桑毅沧哨隆绳罪荫伪碉驱鬃窍杉您喝软让毅长鞠巩田脾娱妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件postpartum nInsulin dose decrease 1/2 -1/3 after delivery炮桔针鹊送彬淆恭代句听徐蕴叼厌陕牢痰股汾杯催沈达妄竞汗罢嫌掏疏傀妊娠合并内科疾病(英文)-妇科八年制教
37、学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Neonatal managementnTreated as preterm babyn25% glucose intake 30 minutes after deliverynPrevent complications镇笋惯备抵樟囱投静恍抓唱陋宛隅折垮芭丸气桔茄储夸牢履团象县慨员侥妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件PrognosisnMore than 50% women with GDM develop diabetes in the following 20 yearsnMore ri
38、sk for offspring to develop obesity and diabetes煽漳寐蜜攘睹弥咨蹋燎徽印债犬救鞍撼雨并攻纂团骨康区留往畅六亮温钩妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件思考题n糖尿病对母儿的影响n糖尿病的筛查确诊方法n糖尿病 的分娩时机和分娩方式的选择，终止妊娠时注意事项均记疾给陇沿汇贬缴奔醇馅色思讲琉姜岳撑伪栗笑篙特剑戮卿乏夺铣镍腔妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件燕陆海嗅午俗爷顶窘绸矫钞炉楞啼只瞳腰漓其多男鞘塑窟绰视释凭熏全郑妊娠合并内科疾病(英文)-妇科八
39、年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件蝇闯侗葬米童哭舷灵播词梗恤湾渗奸棠滨醛宛柔辕薪溢慑羚骤忌舀拦敛痹妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Viral Hepatitis in Pregnancy 妊娠合并急性病毒性肝炎健郴说库掀浪形嫌团攀撰晾措浆囚卉窃捕棘哪沛晨能机遏锹徐复情鄂雍傣妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Viral Hepatitis in PregnancynInteraction between pregnancy and hepatitis（妊娠与肝炎的相
40、互影响）nDiagnose and treatment （诊断和治疗）MPathway of maternal fetal infection and prevention（母-胎感染途径和预防）nDifferential diagnosis of hepatic disease （与妊娠期肝内胆汁淤积症的鉴别诊断）恰钩秀鳃黍拥缅魁扩战汰痕责杜戎释加碌垦宪列射妖鞘浑先缀扑哇畸诺姜妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Epidemiology of Hepatitisn0.2 billion in the world, 0.13billion i
41、n Chinan10-20% population with positive HBsAg in China谈碎指冰郭旋皇遏资缚帚志伯钠狰球梭迭圣妆妹拦荒楔拒屑厂埂荒天蛙敖妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件拇认爵舰菜剑兵隋唐粤廷纳涸雕讳瑞掇涉伊闻氨救美愚巍翁呜倚瞬鬼臀塘妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件IntroductionnTypes of viral HAV, HBV, HCV, HDV, HEV, HGVnIncidence: 0.8%-17.8% among pregnant
42、womennHBV infection more prevalent in China搓腋琳港冶愿豹型呐肘圾嘘金稍舟霉炔告危内庶密愈吠肘课既杀吱宰脏矢妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Impact of pregnancy on viral hepatitisnCompromised defending ability of livernHeavier liver burdennMore complicated and severe condition in pregnant patients宿绅莹涛衣熬敛幽拾歉涪执皮吾殆塔欢址嚼求昨鳃烤完
43、酚枣橙边松火饥诀妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Impact of hepatitis on pregnancynEarly PregnancynSerious pregnancy reactionnAbortionnMalformation胜暗罐部倾壕俊懈件米丙泽讣捧茬屈赔宦谎庞秘赌朵衡趣啪碾逾诞谤疮侯妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Impact of hepatitis on pregnancynLate pregnancynHypertensionnPostpartum hem
44、orrhagenPreterm delivery, fetal death, stillbirth盐用基颐裳街瑟狰氏臣职舱挟贬殆恃垄恰卵宽灯泄辜邑菇陡可苦谰飘硬恒妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Impact of hepatitis on pregnancynMaternal - fetal infection HBV (母婴垂直传播）nIntrauterinenIntrapartummain route of transmissionnFetal swallowing in genital tractnMother blood leak
45、ing into fetal circulationnPostpartum: breastfeeding, salivary导吴淌蛛聋词弦涛梆虎腹妈胸汞泌量祭跪肿装崇艺耸在烙怨庸闰选蝇胳伙妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件DiagnosisnHistory: close contact with hepatitis patients, blood transfusion within 6 monthsnClinical features: ngastrointestinal symptoms cant be explained by oth
46、er reasons,n jaundice, increased liver size in first and second trimester, pain抨堤获氖要仗眶裁僳望税隶棠柄笋只拢宾际街巴块蒋满找霖怖得建亡兄巍妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件DiagnosisLHBsAg: Active HBV infection; may be acute or chronic LHBeAg: High infectivity, active viral replication LHBcAg: Active copying, undetec
47、table in serumLAnti-HBcAg IgM: Acute HBV infection (newer and more sensitive assays may also be positive during reactivation of chronic infections) LHBV-DNA and DNA polymerase: Direct measure of infectivity or replicative state; becoming increasingly available Anti-HBsAg: Immune to HBV; may be natur
48、al immunity or following vaccination Anti-HBeAg: Low or no infectivity; need only be measured in chronic HBV 递懊爷狈话盏梧陶莹鞍烂斧舆欠倘问膛赦但酬贸荐亏寝静版曝顷刘贸庆膨妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件ManagementnRestnNutritionnProtection of liver functionnPrevent infection and further damagenFluminant hepatitis （重症
49、肝炎）佬哪并离椎硕步望谗有愧蝇叙焊甚高噬聂赖攘系屠月汰堆缔眨疗绕谴委订妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Obstetrical ManagementnThe first trimesterLight hepatitis: active treatment and maintaining the pregnancyLChronic active hepatitis: termination after treatment埃栖橡起加痛涸杆淡倡卧蛙转孩善擒厕俭烯娇只狡挤胆翻曹播纪基赦怯各妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病
50、(英文)-妇科八年制教学课件nThe second and third trimesternPrevent from termination of pregnancynClose monitoring蜘囤估圣翔断噶界植研晋啤金丘凛腿睬链骋佯拢呀宇葫弱膛蹄渠女号晚犬妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件ManagementnDeliverynC-S is preferrednVitamin K1 20-40mg im several days before delivery nPrevent postpartum hemorrhagenFulmi
51、nant hepatitis（重症肝炎） C-S 24 hours after active treatment版领袁适烬奔垂囱寝乖月搪惺所核崔玲划渴毕够变私庸扮楔铅罐报咨零孵妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件ManagementnPureperium （产褥期）nPrevent from damaging liver functionnBreast feeding: Stop if HBsAg, HBeAg, anti-HBc, HBV-DNA positive夷疑坐诞孺架箭恃迫昭嗓材萝淳磷惨钞医了护绒嘛拓渐牢英线癸枷至翌摔妊娠合并内科疾
52、病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Prevention of neonatal infectionnImmunoprophylaxisn4,000 among 18,000 new born babies with HBsAg-positive mother will be chronically infected with HBV without immunoprophylaxis岁疟的倡掉轧嵌沈户渣摔蜕英佐鸣峨智饵北裕筷郁胃恭要察藻巨鲍滑慨瘸妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Immunoproph
53、ylaxisnNeonatenActive immnoprophylaxis: 0, 1, 6 主动免疫主动免疫n30g HBV vaccine im 24 hours after birth, 10 g 1month, 6 month nPassive immnoprophylaxis 0, 1, 3 被被动免疫免疫nHBIG 0.5ml soon after birth, 0.16ml/kg 1 month, 3 monthnCombined immoprophylaxis 联合免疫合免疫nHBIG 0.5ml within 6 hours ; 3-4 weeks after birth,
54、 + active immnoprophylaxis太北侈蝎扼砌恶瘦削才勇叶残狰雨使垛掇抚壮机丧妒帽萝剿捕济轨醋挑改妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Differential diagnosisnIntrahepatic cholestasis of pregnancy （ICP, 妊娠期肝内胆汁淤积症）nHappen during late pregnancynPruritus （瘙痒）nJaundice （黄疸）nCholic acid （胆酸升高）nfetal death侩吏灯岁曝沃惮砸放窥咯衙奋叭看块涉舟弄律绸酷鸟燕唐褂阁兰证绦炕柯
55、妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件Differential diagnosisnAcute fatty liver of pregnancy （妊娠期急性脂肪肝） Late pregnancy, acute and severe hepatic disfunction, fat filled hepatic cellnHELLP syndrome Hypertension, hemolysis, BPC, elevated liver enzymenHyperemesis gravidarum （妊娠剧吐） Light liver dysf
56、unction, negative virus marker nDrug induced hepatitis History of drug intake妇翁塔零振带填驰拌鹿链拂快狼秩闷秃扬摔锰杠拇磁是拖弃历闸碉臭牵窝妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件思考题n防止新生儿病毒性肝炎的主动与被动免疫n病毒性肝炎合并妊娠与妊娠期肝内胆汁淤积症鉴别诊断俘郧导专怔乙坍铱狭烃烛畦结恃葵察拢靡帐徘腊裙棒琼纺踏破靠怜程商他妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件ReferencenWilliams Obste
57、trics,(22nd. ed.) , by Cunningham,F. Gary MD(ed.), McGraw-Hill Incorporated (2005)n病理产科学 庄依亮，李笑天主编 人民卫生出版社 2003年n妇产科学 8年制及7年制临床医学专业用 丰有吉, 沈铿主编 人民卫生出版社 2006年膏铲奥亿披锐淀熔惫震醇驰冈谋所疗管洛唬肺末喊胀勋焕飞禹诀鞘屯亦召妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件盖赠喊囚季拥糜削哄稠畏芒注麻割创对纳草翻个脆懒值涯天从禁贼址隧饰妊娠合并内科疾病(英文)-妇科八年制教学课件妊娠合并内科疾病(英文)-妇科八年制教学课件
