gestational妊ㄖㄣˋ娠ㄔㄣˊ→labor生產
危險因子[]
- 糖尿病
- essential hypertension(本態性高血壓)
分類和治療學[]
gestational妊ㄖㄣˋ娠ㄔㄣˊ hypertension[]
(用methyldopa 250 mg 2~3 times daily,alternative: clonidine,methyldopa+hydralazine可用在慢性高血壓):hypertension without proteinuria and/or pathologic edema( BP > 140/90 mm Hg )
子癇前症 和子癇症[]
preeclampsia 子癇前症[]
(由low-dose 60mg/day Aspirin預防,對已發生的沒有用)
- mild:hypertension accompanied by proteinuria and/or pathologic edema( proteinuria >300mg/24hr or 100 mg/dL in 2 random samples 6 hr apart and/or pathologic edema)
- severe:hypertension accompanied by proteinuria and/or pathologic edema( proteinuria > 4g/24hr or persistent value of 2+ are present by dipstick, BP is 160/110 mm Hg , and/or server headache , visual disturbance , or epigastric pain is noted.
子癇症[]
(IV or IM MgSO4可以預防):development of generalized seizure in Pregnance-induced hypertension,無法以MgSO4治療的可以用IVdiazepam或是phenytoin治療。如果MgSO4中獨可以用Calcium gluconate解毒
treatment[]
- hydralazine(IV) + propanolol
- diaxoside:會造成母體和neonate高血糖、母體低血壓和生產抑制
- labetalol:aceptable alternative to hydralazine
- nitroprusside sodium可以用在hypertensive emergency,但是因為可能發生cyanide toxicity所以要避免用在嬰兒
- beta-blocker
- CCB:nefedipine,一般不用。哺乳婦可用
- ACEI不能用在懷孕;captopril和enalapril可用於哺乳婦
- Diuretic除了late gestation for refractory hypertension外不要用。可以用thiazide和loop diuretics。loop diuretics會抑制乳汁分泌所以不用再哺乳婦,thiazide要小心抑制乳汁分泌,acetazolamide和spironolactone通過乳汁很少所以可以用
重點[]
- gestational妊ㄖㄣˋ娠ㄔㄣˊ hypertension(用methyldopa 250 mg 2~3 times daily,alternative: clonidine,methyldopa+hydralazine可用在慢性高血壓)
- 子癇前症和子癇症
- preeclampsia子癇前症(由low-dose Aspirin預防,對已發生的沒有用)
- mild
- severe
- 子癇症(MgSO4可以預防):development of general seizure in Pregnance-induced hypertension
- hydralazine(IV) + propanolol
- diaxoside:會造成母體和neonate高血糖、母體低血壓和生產抑制
- labetalol
- nitroprusside sodium可以用在hypertensive emergency,但是因為可能發生cyanide toxicity所以要避免用在嬰兒
- beta-blocker
- CCB:nefedipine,一般不用。哺乳婦可用
- ACEI不能用在懷孕;captopril和enalapril可用於哺乳婦
- Diuretic除了late gestation for refractory hypertension外不要用。可以用thiazide和loop diuretics。loop diuretics會抑制乳汁分泌所以不用再哺乳婦,thiazide要小心抑制乳汁分泌,acetazolamide和spironilactone通過乳汁很少所以可以用
- preeclampsia子癇前症(由low-dose Aspirin預防,對已發生的沒有用)
參考資料[]
section18/OB-GYM disorders