Pregnancy-induced hypertension syndrome (Hypertensive disorders complicating pregnancy Professor of obstetrics and gynecology Lin Qi De
Pregnancy-induced Hypertension syndrome (Hypertensive disorders complicating pregnancy) Professor of obstetrics and gynecology Lin Qi De
Term PIHS is an acute or specific hypertension of pregnancy which is peculiar to pregnant or puerperal women Diagnosis of PIHs is made on the basis of development of hypertension with or without proteinuria, edema or both after the twentieth week of gestation although the signs and symptoms may appear earlier with hydatidiform moles
Term : PIHs is an acute or specific hypertension of pregnancy which is peculiar to pregnant or puerperal women .Diagnosis of PIHs is made on the basis of development of hypertension with or without proteinuria ,edema ,or both after the twentieth week of gestation ,although the signs and symptoms may appear earlier with hydatidiform moles
Classification: 1. Mild: Bp 2140/90mmHg or Bp has a rise of 30mmH systolic pressure or 15 mmHg diastolic pressure(4/2 Kpa)over the prepregnant level, with or without trace proteinuria or edema 1. gestational hypertension) 2. Moderate: Bp <160/110 mmHg (21.3/14.6 Kpa ),with proteinuria“+” or edema 2. preeclampsia/mild) 3. Severe: Bp 2160/110 mmHg(21. 3/14.6Kpa), with proteinuria ++or edema (2. preeclampsia/severe) (1) preeclampsia: above-described signs with headache visual disturbances and tightness of chest. ( 2. preeclampsia/severe) (2) Eclampsia: the signs and symptoms of pre-eclampsia with convulsion 3. eclampsia)
Classification : 1. Mild : Bp ≥140/90mmHg or Bp has a rise of 30mmHg systolic pressure or 15 mmHg diastolic pressure (4/2 Kpa ) over the prepregnant level,with or without trace proteinuria or edema. (= 1. gestational hypertension) 2. Moderate :Bp <160/110 mmHg (<21.3/14.6 Kpa ) ,with proteinuria “+” or edema . (= 2. preeclampsia/mild) 3. Severe : Bp ≥160/110 mmHg (21.3/14.6Kpa), with proteinuria “++” or edema . (= 2. preeclampsia/severe) (1) preeclampsia : above-described signs with headache ,visual disturbances and tightness of chest.(= 2. preeclampsia/severe) (2) Eclampsia : the signs and symptoms of pre-eclampsia with convulsion . (= 3. eclampsia)
Etiology. 1. Utero-placental ischaemia: Abnormal development of the placental bed vessels /shallow trophoblast invision in spiral arteries /acute arterosis 2. Endothelial cell activation/dysfunction. Cytotoxic factors: oxygen free raicals /lipid peroxidation /very low density lipoprotein(vlDL)/fibronection / platelet derived growth factor( PDGF)/tumor necrosis factor-a(TNF-a)/interleukins-6(IL-6) anti-vascular endothelial factor / endothelial inhibitive factor 3. Immunity i (1) fail to express HLA-G mRNA or protein (2)abnormal maternal immune situation such as Ts/Th decrease and ThI function dominent 4. Genetics gene recessive trait
Etiology : 1. Utero-placental ischaemia : Abnormal development of the placental bed vessels / shallow trophoblast invision in spiral arteries / acute arterosis / 2. Endothelial cell activation/dysfunction: Cytotoxic factors : oxygen free raicals /lipid peroxidation / very low density lipoprotein(VLDL) /fibronection / platelet derived growth factor( PDGF) / tumor necrosis factor-a (TNF-a) /interleukins-6 (IL-6) / anti-vascular endothelial factor /endothelial inhibitive factor 3. Immunity ; (1) fail to express HLA-G mRNA or protein . (2) abnormal maternal immune situation such as Ts/Th decrease and Th1 function dominent . 4. Genetics : gene recessive trait
Pathophysiology. Basic pathophysiology changes: spasm of the arterioles activationdamage of endothelium ---reduced organ perfusion: Hypertension Proteinuria/Edema Pathology: hemorrhage /ischemia /necrosis/ 1. Placenta 1) premature aging of villi (2) hemorrhage () necrosis 2. Kidney ----glomerular changes (1) swelling of endothelial cells (2)the deposition of amorphous materials in cytoplasm produce enlargement (3) swelling of the glomerular capillarities
Pathophysiology : Basic pathophysiology changes : spasm of the arterioles --- activation/damage of endothelium ---reduced organ perfusion :Hypertension / Proteinuria / Edema Pathology : hemorrhage /ischemia /necrosis/ 1. Placenta : (1) premature aging of villi (2) hemorrhage (3) necrosis 2. Kidney ----glomerular changes (1) swelling of endothelial cells (2) the deposition of amorphous materials in cytoplasm produce enlargement (3) swelling of the glomerular capillarities