单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,Your company slogan,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,Hypertensive Disorders in Pregnancy,Teng YinCheng,Shanghai Jiaotong University Affiliated Sixth Peoples Hospital,Dept of Obs&Gyn,Hypertensive Disorders in Pre,Contents,Etiology&Pathogenesis,Clinical features,Physiopathology,Classification,Diagnosis,Management,2,3,4,5,6,1,Contents Etiology&Path,Incidence and Risk Factors,Incidence,Commonly about 5 percent,Markedly influenced by parity,Related to race and ethnicityA genetic predisposition,Main Risk Factors,Nulliparous(,初产妇,),Multiple pregnancy,History of chronic hypertension,Maternal age over 35 years,Obesity,Lower socioeconomic status,Incidence and Risk FactorsInci,Roberts,J.M.et al.Hypertension 2005;46:1243-1249,Used with permission,Two-stage model of the pathophysiology of preeclampsia,Stage 2 develops in some,but not all women with stage 1,Etiology and Pathogenesis,Roberts,J.M.et al.Hyperten,Etiology and Pathogenesis,Normal:,vessel remodeling(,血管重铸,)of the,decidua and myometrium,transforming into,large-capacitance,low-resistance,vessels,Preeclampsia:,incomplete remodeling,limited to the,superficial decidua,myometrial segments remain,narrow,Faulty Placentation(,胎盘形成不良,)-Stage I,Etiology and PathogenesisNorma,妊娠期高血压疾病课件,妊娠期高血压疾病课件,Etiology and Pathogenesis,Oxidative distress,（氧化应激）,Incomplete vessel remodeling Reduced placental perfusion placenta ischemia,（缺血）,and hypoxemia,（缺氧）,Oxidative distress Endothelia dysfunction affected production of,Nitric Oxide/,Prostaglandins,（前列腺素）,Other factors,Immune system dysfunction,Genetic predisposition,Malnutrition,Etiology and PathogenesisOxida,Pathogenesis of preeclampsia,Genetic factors,immunological factors,Maternal vascular disease,Environmental factors,Reduced uteroplacental perfusion,Faulty placentation,Endothelial activation,Systemic vascular dysfunction,Capillary leak,vasospasm,Hypertension,Cerebral edema(eclampsia),Edema,Proteinuria,Coagulation abnormalities(HELLP),Fetal growth restriction(FGR),Pathogenesis of preeclampsiaGe,Physiopathology -sgage II,Basic change:,System Vasospasm,（全身小动脉痉挛）,Hemorrhage,edema,hyperemia,充血,thrombosis,Visual disturbances:blurred vision,blindness,retinal detachment,（视网膜脱落）,Reduced renal perfusion and glomerular filtration,肾小球滤过率,Proteinuria;increased uric acid;oliguria,Ischemia,edema,elevated serum transaminases(ALT,AST,AKP.);jaundice,（黄疸）,Subcapsular hematoma(,肝包膜下出血,)or hepatic rupture,Physiopathology -,Physiopathology,Peripheral vascular resistance,cardiac output(,低排高阻,),blood pressure,Cardiac failure(,心力衰竭,),pulmonary edema(,肺水肿,),Blood volume,hematocrit (HCT,红细胞压积,),blood concentration,H,ypercoagulability,(,高凝,),thrombocytopenia(,血小板减少,),Placental ischemia and hypoxia,High-resistance circuit with decreased blood,Fetal growth restriction,fetal distress(,胎儿窘迫,),Physiopathology Peripheral vas,Clinical manifestation,Hypertension,Edema,Proteinuria,Severe cases,H,eadache,blurred vision,nausea,vomit,right upper quadrant pain,seizure(,抽搐,),Usually occurs after 20 gestational weeks,Clinical manifestationHyperten,WHAT LINKS STAGE 1&2?,Theory exploration:,Genetics/Abnormal lipid metabolism,Endocrine dysfunction,Inflammation,WHAT LINKS STAGE 1&2?Theory,Not all women with reduced placental perfusion develop preeclampsia,What links stages 1 and 2?,Reduced placental perfusion must,interact,with maternal factors to result in preeclampsia.,Stage 1,?,Stage 2,Roberts,J.M.,Gammill H.S.(2005),Not all women with reduced pla,Diverse manifestations are possible:maternal and fetal/placental factors may vary in proportion.,In a woman with,many,predisposing factors,even a minor reduction in placental perfusion is sufficient for stage 2 to develop.,In a woman with,few,predisposing factors,a profound reduction in placental perfusion may be required for preeclampsia to develop.,Roberts,J.M.,Gammill H.S.(2005),Predisposing factors,Reduced placental perfusion,Microsoft Office 2000,Diverse manifestations are pos,Could maternal genetics play a role in the link between stage 1&2?,Stage 1,Stage 2,Genetics,Could maternal genetics play a,What do we know?,We know that abnormalities in lipid metabolism have a genetic basis.,We have learned that preeclampsia is characterized by profound lipid abnormalities such as hypertriglyceridemia,Gratacos,E.(2000),Microsoft Office 2000,What do we know?We know that,Could abnormal lipid metabolism be a genetic factor linking the stages of preeclampsia?,Stage 1,Stage 2,Abnormal lipid metabolism,Could abnormal lipid metabolis,Preeclampsia is characterized by metabolic abnormalities similar to those present in atherosclerosis:,Hypertriglyceridemia,Reduced HDL cholesterol,Predominance of small-dense LDL cholesterol which have an increased potential to cause endothelial cell damage as compared to larger,more buoyant LDLs.,Gratacos E.,2000.,Preeclampsia is characterized,Stage 1,Abnormal lipid metabolism,Stage 2,In the presence of oxidative stress and inflammation,susceptible small-den