妇产科学教学课件：6 妊娠合并病毒性肝炎

PregnancycomplicatesViralHepatitis

妊娠合并病毒性肝炎FunctionofliverproductsandsecretsproteinsPlayrolesinmetabolismofcarbohydrates,lipidsSynthesizescoagulationfactorsI,II,V,VII,VIII,IX,XandXI,aswellasproteinC,proteinSducesandexcretesbile(whichhelptheabsorptionofvitaminKfromthediet)breakdownofinsulinandotherhormonesEtc.2Viralhepatitis:HepatitisAHepatitisBHepatitisCHepatitisDHepatitisEOtherviruses3Symptomsofviralhepatitis4Symptomsofviralhepatitis5HepatitisA6HepatitisB:7HepatitisB:8HepatitisB:9HepatitisC:10HepatitisD:11HepatitisE:12Agiftaninterestingwebsite:/wiki/File:Viral_hepatitis.webm13DifferentialdiagnosisICP(intrahepaticcholestasisofpregnancy)HELLPsyndrome(hemolysis,elevatedliverenzymes,lowplatelets)Acutefattyliverofpregnancy14TreatmentAnti-viraltherapyMedicationforprotectionofliverLaboranddeliveryBreast-feeding15ProphylaxisHBVimmunoprophylaxisVaccinesforpeopleathigh-riskofcontactingHBVinfectionMother：BepassivelyimmunizedwithhepatitisBIg(HBIg)inthethirdtrimester(50%↓)Infant:receivecombinedtherapywithHBIgandvaccination16KeywordsVerticaltransmissionDifferentialdiagnosisofviralhepatitis17GestationalDiabetesMellitus（GDM)

妊娠期糖尿病上海交大医学院附属仁济医院妇产科张羽博士，副主任医师rjzhangyu@163.com2016年2月26日ClassificationGestationaldiabetes:diagnosedduringpregnancy（90%）Overtdiabetesduringpregnancy(10%)tohavediabetesbeforepregnancy19DMisametabolicdisordercharacterizedbyhyperglycemiaThecauseofDMismultifactorial(genetic,immune,environmental,viral,)GDM:1%~5%inChina3%-10%inUSA20Effectsofpregnancyonglucosemetabolism/diabetes1.Diataryhabitschanges2.Insulinloadincrease3.Anti-insulinhormonesfromplacentaprolactinestrogenprogesteroneinsulinase21MaternaleffectsGlucosuriaHyperglycemiaDiabetesketoacidosisInfectionPIH/PreeclampsiaNephropathy(肾病），retinopathy(视网膜病）Neuropathy（神经病）22Fetal/neonataleffectsAbortionPretermdeliveryCongenitalanomalies,malformationsMacrosomiaHydramnios(羊水过多）RespiratorydistressHypoglycemia,HypocalcemiaHyperbilirubinemia(高胆红素血症）Polycythemia(红细胞增多症）23DiagnosisofOvertdiabetesduringpregnancyHasadiabeteshistory;OrHighriskpatientswithoneofthefollowing:FPG(fastingplasmaglucose)≥7.0mmol/LHbA1C≥6.5%Randomplasmaglucose≥11.1mmol/LandFPG≥7.0mmol/LorHbA1C≥6.5%inthenextday24DiagnosisofGDMAllpregnacywomenshouldbescreenedforGDMbetween24-28weeks’gestationFBG(fastingblood-glucose)>=5.1mmol/Ltwiceafter24weeksofgestation25DiagnosisofGDMOnwomenwithFBG<5.1mmol/Lafter24weeksofgestationGlucosechallengetest[GCT])Measuringtherandomplasmaorserumglucoseconcentration1houraftera50-goralglucoseload(abnormal>=7.8mmol/L)

26DiagnosisofGDMOnwomenexceedingtheglucosethresholdvalue(>=7.8mmol/L)onGCT.Oralglucosetolerancetest(OGTT):Fastingforatleast8hour,75g-oralglucoseloadO-hour<5.1mmol/L1-hour<10.0mmol/L2-hour<8.5mmol/LBediagnosedIfanyoneormoreserumglucosevaluesmeetorexceed27White’sclassificationofDMinpregnancyA:GDM(A1,A2)B:onsetat≧20yearsofageordurationof<10yearsC:onsetat10-19yearsofageordurationof10-19yearsD:onsetat<10yearsofageordurationof≧20yearsoranyonsetordurationwithbackgroundretinopathyorhypertensiononly28White’sclassificationofDMinpregnancyF:Nephropathy(>500mgproteinperdayat<20weeksofpregnancyH:Arterioscleroticheartdisease,clinicallyevidentR:proliferativediabeticretinophyorvitreoushemorrhageT:historyofrenaltransplant29TreatmentEducationStandarddietarytoprovidethenecessarynutrientstocontrolglucoseleveltopreventstarvationketosisdailycaloricintake:30Kcal/Kg/Day+300-500calExerciseInsulintherapyMonitorofbloodglucoselevel30TreatmentPlasmaglucoseleveltarget:30’beforethreemeals<5.3mmol/L2hafterthreemeals<6.7mmol/L31TreatmentObstetricalmanagementmaternalevaluation