11妊娠合并内科疾病(英文)-陈晓军.ppt

11妊娠合并内科疾病(英文)-陈晓军.ppt

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MEDICALCOMPLICATIONSINPREGNANCY妊娠合并内科疾病,陈晓军复旦大学附属妇产科医院,Cardiovasculardiseases,Pulmonarydisorders,Renalandurinarytractdisorders,Gastrointestinaldisorders,Hematologicaldisorders,Connectivetissuedisorders,Neurologicalandpsychiatricdisorders,Endocrinedisorders,Dermatologicaldisorders,Neoplasticdiseases,Infections,HeartDiseases,Diabetes,Hepatitis,Disease,HeartDiseaseinPregnancy,妊娠合并心脏病,Heartdiseaseinpregnancy,Interactionbetweenheartdiseaseandpregnancy（心脏病与妊娠的相互影响）Peripartumcardiomyopathy,PPCM（围产期心肌病）Medicaltreatmentofpregnantwomencomplicatedwithheartdisease（妊娠合并心脏病的治疗）,Iwantababy,27yearsoldAtrialseptaldefect1cmFeeldiscomfortonlyafterordinaryactivity,CanIhaveababy?

Whatistheriskformeandmybaby?

WhatshouldIdoduringthecourseofpregnancy?

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?

Whatistheriskformeandmybaby?

WhatshouldIdoduringthecourseofpregnancy?

BywhichwayshouldIdeliverymybaby?

Anyspecialthingtobepaidattentiontoafterbirth?

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