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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11妊娠合并内科疾病(英文)-陈晓军PPT格式课件下载.ppt

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

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