扬州大学：《妇产科学》课程教学课件（PPT讲稿）08 妊娠期高血压疾病 Hypertensive Disorders of Pregnancy 1/2

Hypertensive Disorders ofPregnancy

I.IntroductionHypertension is defined as elevation either ofsystolic blood pressure (BP) to 140 mm Hg, orhigher, or diastolic BP to 90 mm Hg, or higher,on two separate occasions at least 6 hours apartbut no more than 7 days apart

 Hypertension is defined as elevation either of systolic blood pressure (BP) to 140 mm Hg, or higher, or diastolic BP to 90 mm Hg, or higher, on two separate occasions at least 6 hours apart but no more than 7 days apart

Il.Classification and Definitions1.ChronicHypertension:hypertensiondiagnosed beforepregnancy,before 20 weeks'gestation, or elevated BP thatis first diagnosed during pregnancy and persistsafter42dayspostpartum

 1.Chronic Hypertension:  hypertension diagnosed before pregnancy, before 20 weeks' gestation, or elevated BP that is first diagnosed during pregnancy and persists after 42 days postpartum

2.Pre-eclampsia:onsetofelevatedBPandproteinuriaafter20weeks'gestation in a patient known previouslyto be normotensive.Exceptions are in the casesof trophoblastic disease or multiple gestation,when pre-eclampsia may appearbefore 20weeks'gestation

 2.Pre-eclampsia:  onset of elevated BP and proteinuria after 20 weeks' gestation in a patient known previously to be normotensive. Exceptions are in the cases of trophoblastic disease or multiple gestation, when pre-eclampsia may appear before 20 weeks' gestation

>A.Mild Pre-eclampsia.The following criteria must bemet to confirm the diagnosis of mild pre-eclampsia:BPof140/90mmHgorhigherafter20weeksgestation,measured on two occasions at least 6hoursbut no morethan7days apartProteinuria greater than 300 mg in a 24-hour urinecollectionora scoreof 1+ (30 mg/dL)onatleasttworandom urine dipstick tests collected 6hours but nomorethan7days apart

 A. Mild Pre-eclampsia. The following criteria must be met to confirm the diagnosis of mild pre-eclampsia:  BP of 140/90 mm Hg or higher after 20 weeks' gestation, measured on two occasions at least 6 hours but no more than 7 days apart  Proteinuria greater than 300 mg in a 24-hour urine collection or a score of 1+ (30 mg/dL) on at least two random urine dipstick tests collected 6 hours but no more than 7 days apart

B.Severe Pre-eclampsia.The following criteria areused to confirm the diagnosis of severe pre-eclampsia a.BP during bed rest of 160 mm Hg systolic or 110mm Hg diastolic,measured on two occasions at least6hours apart but no morethan 7 days apart,and/orb.Proteininuriagreater than5gina 24-hourcollection even if associated with Bps in the mild rangeUrine dipstick should not beused for diagnosis; or

 B. Severe Pre-eclampsia. The following criteria are used to confirm the diagnosis of severe pre-eclampsia:  a. BP during bed rest of 160 mm Hg systolic or 110 mm Hg diastolic, measured on two occasions at least 6 hours apart but no more than 7 days apart; and/or  b. Protein in uria greater than 5 g in a 24-hour collection even if associated with Bps in the mild range. Urine dipstick should not be used for diagnosis; or

c. Elevated BP (mild or severe) accompanied byany of the following:Oliguria, indicated by a 24-hour urineoutputof less than 500 mLCerebral or visual disturbances,includingaltered consciousness,headache, scotomata,blurred vision, or some combination of thesePulmonaryedema

 c. Elevated BP (mild or severe) accompanied by any of the following:  Oliguria, indicated by a 24-hour urine output of less than 500 mL  Cerebral or visual disturbances, including altered consciousness, headache, scotomata, blurred vision, or some combination of these  Pulmonary edema

Epigastric or right upper quadrant pain associatedwith impaired liver function without a known cause,indicatedbyelevated serumlivertransaminasesThrombocytopenia, indicated by a platelet count lowerthan100,000/mm3Evidence of microangiopathic hemolytic anemia, suchas abnormal findings onperipheral smear,increasedbilirubin level, or elevated lactate dehydrogenase (LDH)

 Epigastric or right upper quadrant pain associated with impaired liver function without a known cause, indicated by elevated serum liver transaminases  Thrombocytopenia, indicated by a platelet count lower than 100,000/mm3  Evidence of microangiopathic hemolytic anemia, such as abnormal findings on peripheral smear, increased bilirubin level, or elevated lactate dehydrogenase (LDH)

C.HELLP syndrome.A variant of severe pre-eclampsia when the following criteria are present (1)[Note:Hypertensionmaybeabsent (12%to 18%)mild (15% to 50%), or severe (50%). Proteinuria maybe absent as well (13%).)Thrombocytopenia. A platelet count of less than100,000/mm3isthemostconsistentfinding inHELLP syndrome.Hemolysis is defined as the presence of abnormalperipheral smear results with burr cells andschistocytes, elevated indirect bilirubin level, and LDHlevel orlow serumhaptoglobin levels.Hematocrit willdrop as well.Elevated liver function testresults

 C. HELLP syndrome. A variant of severe pre￾eclampsia when the following criteria are present (1). [Note: Hypertension may be absent (12% to 18%), mild (15% to 50%), or severe (50%). Proteinuria may be absent as well (13%).]  Thrombocytopenia. A platelet count of less than 100,000/mm3 is the most consistent finding in HELLP syndrome.  Hemolysis is defined as the presence of abnormal peripheral smear results with burr cells and schistocytes, elevated indirect bilirubin level, and LDH level or low serum haptoglobin levels. Hematocrit will drop as well.  Elevated liver function test results

3.EclampsiaEclampsia is generallydefined as pre-eclampsiaaccompanied by convulsions and/orunexplained coma.However, eclampsia maydevelop in the absence of hypertension (16%)orproteinuria(14%)(2)

 3.Eclampsia  Eclampsia is generally defined as pre-eclampsia accompanied by convulsions and/or unexplained coma. However, eclampsia may develop in the absence of hypertension (16%) or proteinuria (14%) (2)