11妊娠合并内科疾病(英文)-陈晓军PPT格式课件下载.ppt
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BywhichwayshouldIdeliverymybaby?
Anyspecialthingtobepaidattentiontoafterbirth?
HeartDisease,Incidence:
1-4%ofpregnanciesOneoftheleadingcausesofmaternaldeath(8.3%)Deathrate0.6%-2.7%,Heartdisease,hemodynamicBurdern,Heartfunction,32-34weeksofpregnancyIntrapartumPuerperium(3dayspostpartum),Interactionbetweenpregnancyandheartdisease,Clinicalsignificanceofheartdiseaseinpregnancy,Mother:
heartfailure;
infectiveendocarditis;
hypoxiaandcyanosis;
thrombenbolismBaby:
miscarriage(流产),stillbirth(死产),fetalgrowthrestriction(生长受限),fetalandnewborndistress(呼吸窘迫),pretermdelivery(早产)Increasedcaesareansectionrate(剖宫产)DrugeffectHereditarycongenitalheartdisease(先天性心脏病),ClassificationofHeartDisease,Congenitalheartdisease(先天性心脏病)Left-torightshuntRight-toleftshuntNon-shuntRheumaticheartdisease(风湿性心脏病)Hypertensiveheartdisease(妊娠期高血压疾病性心脏病)Peripartumcardiomyopathy(PPCM)Myocarditis(心肌炎),Peripartumcardiomyopathy(PPCM)围产期心肌病,Dilatedcardiomyopathyoccursduringthelast3monthsofpregnancyto6monthspostpartum(increasedheartsize,decreasedheartfunction)EtiologyunknownNohistoryofcardiovasculardiseaseDiefromheartfailure,arrhythmiaorpulmonaryinfarction50%recover6monthspostpartumRecurinthesuccessivepregnancyClinicalImplications:
10-30%offetaldeathTherapyTreatmentforheartfailureHearttransplantation,CardiacFunction,SubjectivecapacityClassI:
UncompromisedClassII:
SlightlycompromisedClassIII:
MarkedcompromisedClassIV:
SeverelycompromisedObjectiveexaminationA:
WithoutobjectivebasisofcardiacdiseaseB:
MildcardiacdiseaseaccordingtoobjectiveexamC:
ModerateD:
Severe,Management,TOBEORNOTTOBE,?
Protectthemothersheart,Preconceptionalcounseling,PregnancyYESorNO?
Preconceptionalcounseling,YESMildCardiacfunctionIIINohistoryofheartfailureNocomplication,NOSevereCardiacfunction一HistoryofheartfailurePulmonaryhypertensionRight-to-leftshuntsSeverearrythmiaActiverheumaticheartdiseaseAcuteMyocarditis,endocarditis35ywithlonghistoryofcardiacdisease,DuringPregnancy,DeterminewhetherornotthepregnancyshouldbecontinuedNO:
inducedabortionbefore12weeksYES:
IntensivecareduringpregnancyEarlydiagnosisandtreatmentofcongestiveheartfailure,IntensivecareduringpregnancyDetectcongestiveheartfailureasearlyaspossiblebefore20weeks:
1timeper2weeksafter20weeks:
1timeperweekHospitalizedat36-38weeks,Duringpregnancy,Heartfailure-preventionLimitedphysicalactivityControlofbodyweight:
increase12Kg(0.5Kg/month)Limitedsaltintake:
4-5g/dayPreventriskfactors:
infection,anemia,arrhythmia,hypertensivediseasesDynamicobservationofcardiacfunction,DuringPregnancy,Heartfailure-earlydiagnosisDevelopmentofdyspneaandpalpitationonexertionHeartrate110bpm;
breathrate20/minNocturnalcoughPersistentbasilarrales,Duringpregnancy,TreatmentofheartfailureDigoxinDiureticsVesseldilatingagentsTerminationofpregnancy:
C-STimingTerminationafterheartfailureiscontrolledC-Swhenheartfailurecouldnotbecontrolled,Intrapartummanagement,PatternofdeliveryCesareansectionVaginaldeliveryHeartfunctionI-IIVerygoodobstetricalconditionVaginaldelivery-preventheartfailureFirststage:
intensivecareandsedationSecondstage:
shortenthecourseThirdstage:
Addpressureonabdomenpreventpostpartumhemorrhage,Puerperiummanagement,Intensivecareduringthefirst3daysPreventinfectionBreastfeedingSterilization,YesHeartfailurefetaldemisecongenitalheartdiseaseIntensivecareandearlydiagnosisofheartfailureVaginaldeliveryPreventinfectionandpostpartumhemorrhage,CanIhaveababy?
思考题,妊娠合并心脏病哪些情况不宜妊娠?
妊娠合并心脏病分娩方式的选择?
阴道分娩过程中的注意事项。
Diabetescomplicatingpregnancy,妊娠合并糖尿病,Diabetescomplicatingpregnancy,Gestationaldiabetesmellitus(GDM)andovertdiabetescomplicatingpregnancy(妊娠期糖尿病和显性糖尿病合并妊娠)Diabetespregnancy(糖尿病与妊娠的相互影响)Screeninganddiagnosis(筛查和诊断)Managementofwomencomplicatingdiabetesduringpregn