Excessive uterine contraction
[Summary]
Including the production of uterine contractility, and the abdominal muscle contraction of the diaphragm muscle and anal contraction, with the main uterine contractility. In the delivery process, uterine contraction of the rhythm, symmetry and not normal polarity or intensity, frequency changes, known as abnormal uterine contractility. Clinical more production, or because of fetal abnormalities form factors obstruction dystocia, the fetus through the birth canal resistance increased, resulting in production of secondary abnormalities. Abnormal uterine contractility of the weak and divided into uterine contractions in the uterine contraction strong two categories, and each category, for the coordination and uncoordinated contraction of the uterus and uterine contraction.
[Treatment]
(1) Coordination of excessive uterine contraction
A maternal history of radical production in the pre-production period of 1 to 2 weeks before it is not appropriate to leave out, so as to avoid accidents and conditions should be hospitalized early production. After the enema not labor. Chachan well ahead of neonatal asphyxia and rescue preparations.勿使maternal when the baby is delivered downward breath. If there was not enough time to disinfect and radical production plunged newborn, newborn should intramuscular injection of vitamin K1 prevention of intracranial hemorrhage, and early anti-tetanus toxin injection Refining 1500 U. Postpartum carefully examined cervix, vagina, vulva, and if so torn timely suture. If it is not disinfected Chachan, should be given antibiotics to prevent infection.
(B) uncoordinated contraction of the uterus too
1. Ankylosing uterine contractions when diagnosed with ankylosing spondylitis, a uterine contraction, it is timely to contractions inhibitors, such as magnesium sulfate 20 ml 25% by adding 20 ml of 5% glucose slow intravenous injection, or 1 mg epinephrine added 250 ml of 5% glucose in the veins Drip. If it is the obstruction of reasons, the trip should immediately cesarean section. If intrauterine fetal death can be inhaled ether anesthesia. Following the above address, if still not lifted ankylosing uterine contraction, consideration should be given to cesarean section.
2. Narrow ring of uterine cramps should be seriously looking for uterine cramps result of the reasons for the narrow ring, promptly gave correct. Stop all stimulation, such as the prohibition of the operation of the vagina, such as oxytocin suspended. Without signs of fetal distress may be given sedatives such as morphine or meperidine, the general will remove abnormal contractions. When resume normal uterine contractions, vaginal delivery or feasible for natural childbirth. If the above treatment of uterine cramps narrow ring can not be relieved, I did not open the whole Palace, the first disclosure of the child, or with signs of fetal distress, should be immediately Bank cesarean section. If intrauterine fetal death, I have been open the whole Palace, feasible ether anesthesia by vaginal delivery.
[Clinical]
(1) Coordination of excessive uterine contraction
Uterine contraction of the rhythm, symmetry and polarity are normal, and only a strong uterine contractility, and the frequency. If the birth canal without resistance, cervical rapidly in a short time a whole, and the end of maternity leave in a short time, the total labor less than three hours, as radical production. The maternal多见.
Impact on the mother and infant
(1) the impact of the mother: the too frequent contractions, labor and fast, and can be caused by maternal early cervical, vaginal and perineal laceration. Chachan, too late disinfection of puerperal infection. Postpartum uterine muscle fibers shrink-prone bad retained placenta or postpartum hemorrhage.
(2) the impact of fetal and neonatal: contractions impact of the stronger than the frequency of uterine blood circulation placenta, fetal hypoxia in the womb, prone to fetal distress and neonatal asphyxia or even death. The baby is delivered fast, and the fetal head in the birth canal, the pressure on the sudden lifting can be caused by neonatal intracranial hemorrhage. Too late Chachan, newborn vulnerable to infection. If plunged induced fractures, trauma.
(B) uncoordinated contraction of the uterus too
1. Ankylosing uterine contraction ankylosing uterine contraction is not abnormal uterine muscle tissue, almost all caused by abnormal external factors, such as labor occurred after childbirth due to obstruction, or inappropriate use of oxytocin, uterine or placental abruption blood infiltration muscle, the mouth can cause cervical over part of the myometrium in ankylosing spastic contraction. Maternal irritability, persistent abdominal pain, according to resist. Inconsistent with the wrong position unclear, fetal heart rate Tingbuqing. Sometimes, there may be pathological shrink-Central, hematuria, and other signs of uterine rupture threatened.
2. Uterine cramps stenosis Central (constriction ring) uterine wall unit muscle spasm was uncoordinated contraction of the ring formed by narrow, continued to relax, known as uterine cramps stenosis ring. Multi-junction in the womb, from top to bottom, is also available at the Department of carcass of a narrow, fetal neck, the common fetal lumbar (Figure 1).
(1) narrow ring around the fetal neck (2) the narrow ring prone position
Figure 1 of uterine cramps narrow ring
More because of mental stress, fatigue and improper application or contraction of gross due to obstetric treatment. Maternal persistent abdominal pain, irritability, dilated cervix slow decline of the fetus exposed to stagnation, and fetal heart rate, fast, slow. Vaginal examination can be touched narrow aspect of this feature is not part with contractions increased, and pathological shrink-ring different.
Thursday 6 March 2008
Weak uterine contractions
Weak uterine contractions
[Summary]
Including the production of uterine contractility, and the abdominal muscle contraction of the diaphragm muscle and anal contraction, with the main uterine contractility. In the delivery process, uterine contraction of the rhythm, symmetry and not normal polarity or intensity, frequency changes, known as abnormal uterine contractility. Clinical more production, or because of fetal abnormalities form factors obstruction dystocia, the fetus through the birth canal resistance increased, resulting in production of secondary abnormalities. Abnormal uterine contractility of the weak and divided into uterine contractions in the uterine contraction strong two categories, and each category, for the coordination and uncoordinated contraction of the uterus and uterine contraction.
[Treatment]
1. Weak coordination uterine contraction whether primary or secondary, when there is a coordination of uterine contraction weakness, should first look for reasons, whether cephalopelvic disproportion that the wrong position and abnormal fetal and understanding of cervical dilatation first disclosure of the decline situation. If found cephalopelvic disproportion that can not be estimated by vaginal delivery, cesarean section to be timely, if not cephalopelvic disproportion judge said the wrong position and abnormal vaginal delivery can be estimated, should consider measures to strengthen the contractions .
(1) first stage
1) General addressed: the elimination of tension, more breaks to encourage more consumption. Can not eat may intravenous nutritional supplements to Deng 10% glucose 500 to 1000 ml, and vitamin C 2g. Acidosis should be supplemented with 5% sodium bicarbonate. Hypokalemia should be given potassium chloride slow intravenous drip. Maternal fatigue, give stability and the slow intravenous injection of 10 mg or 100 mg intramuscular meperidine, after a period of time, the uterine contractility can be strengthened. On the opening of the cervix primipara less than 3 cm, fetal membranes has not been broken, should be given warm soapy water enema, and promote peristalsis, eliminate waste and Gas, stimulates uterine contractions. Natural urination difficulties, the first induction, should be null and void when catheterization for bladder emptying Road can be widened production, and promote the role of uterine contraction.
2) strengthening the uterine contraction: the normal processing, uterine contractility still weak, confirmed for the coordination of uterine contraction fatigue, no significant progress birth process, the choice of ways to strengthen the contractions:
① artificial rupture of membrane: cervical dilatation 3 cm or more than 3 cm, without cephalopelvic disproportion that the fetal head has been convergence, feasible artificial rupture of membrane. AA, fetal head directly under close of the uterus and cervix, uterus caused reflex contraction accelerating labor progress. Existing scholars advocated fetal head of convergence are also not feasible artificial rupture of membrane that AA can promote fetal head drop Rupen. AA must first check whether the umbilical cord Lu, AA should be carried out in the intermittent contractions. After the rupture of membrane of the fingers should remain in the vagina after 1 or 2 times contractions question fetal head Rupen, then fingers of those removed. Bishop proposed by the score of cervical ripening of the estimated effect of measures to strengthen contractions, as shown in table 1. If maternal and scored three points in the following three minutes, both artificial rupture of membrane failure, should use other methods. 4 to 6 pm the success rate is about 50%, from 7 to 9 pm the success rate is about 80 percent, 9 points above successfully.
Table 1 Bishop cervical maturity score
Index Score
0 1 2 3
Palace opening of the mouth (cm) 0 1 1-2 3-4 5-6
Cervical dissipated (%)
(Not dissipated 2 cm) 0 to 30 40 to 50 60 to 70 80 to 100
First open position
(Ischial spine level = 0) -3 -2 -1 ~ 0 +1 ~ +2
Cervical hardness of soft hardware
I Palace in the former location
② stability (valium) intravenous injection: stability and smooth muscle relaxation can cervix, cervical softening and promote cervical dilatation. Apply to the slow expansion of cervical and cervical edema. Commonly used dose of 10 mg intravenous injection interval of 2 to 6 hours can be repeated applications, combined with the effects of oxytocin better.
③ oxytocin (oxytocin) infusion: applicable to weak coordination of uterine contractions, fetal heart rate good, the wrong position to normal, proportionate to the first pots. U oxytocin 2.5 will be 5% glucose solution 500 ml, so that the sugar content of each droplet oxytocin 0.33 mU from 8 drops / min or 2.5 mU / min, in accordance with contractions strength to adjust, usually not more than 10 mU / min (30 drops / min), the uterine contractions, the pressure of 6.7 ~ 8.0 kPa (50 ~ 60mmHg), contractions between 2 to 3 minutes, continuing 40 to 60 seconds. For non-sensitive, increase oxytocin dose.
Oxytocin infusion process, the person should be observed contractions, fetal heart rate and blood pressure listen. If there contractions continued listening to one minute or more, or there are changes in fetal heart rate, should immediately stop drip. Oxytocin in the blood half-life of the mother for 2 to 3 minutes, can be improved rapidly after treatment, if necessary that could use tranquilizers to contain its role, if high blood pressure should slow down infusion rate. Because oxytocin has been called anti-diuretic effect, the re-absorption of water increased, there will be Niaoshao, to guard against the occurrence of water intoxication.
④ prostaglandin (prostaglandin, PG) Applications: prostaglandin E2 and F2 α have the duty to promote the role of uterine contraction. For the oral route of administration, intravenous and local administration (posterior fornix placed in the vagina). PGE2 intravenous infusion of 0.5 μ g / min and PGF2 α5μ g / min, usually maintaining effective uterine contraction. If half an hour after the contractions still strong, and may, as appropriate, increase the dose, the largest dose of 20 μ g / min. Prostaglandin response to the vice excessive uterine contractions, nausea, vomiting, headache, rapid heart rate, blurred vision and go far in superficial vein, it should be cautiously uses.
⑤ acupuncture points: the effect of strengthening contractions. Acupuncture usually LI4, Sanyinjiao, Taichong, very, Kuan-yuan, and points on the way to stimulate strong, stay needle 20 ~ 30 minutes. Auricular acupuncture optional uterus, sympathetic, endocrine, and other points.
After the treatment, if no progress or labor there signs of fetal distress, to be timely cesarean section.
(2) The second stage: The second stage of the absence of cephalopelvic disproportion, a weak uterine contractions, uterine contraction should also be strengthened, given oxytocin infusion for labor progress. If fetal head biparietal diameter through the ischial spine plane has been waiting for natural childbirth, or visit Episiotomy, to attract fetal head of midwifery or forceps; if not yet convergence or fetal head with signs of fetal distress, should be held cesarean section .
(3) The third stage: for the prevention of post-partum hemorrhage, before fetal shoulder when exposed to the vagina, I can provide a new base lysergic 0.2 mg intravenous injection, and at the same time given oxytocin 10 to 20 U intravenous drip to enhance uterine contractions , and is delivered to the placenta and uterine stripping sinusoids closed. If middle-long AA long time, should be given antibiotics to prevent infection.
2. Uncoordinated contraction of the uterus is the principle of dealing with weak regulation uterine contractions and restore uterine contraction polarity. Given strong sedatives meperidine 100 mg or 10 to 15 mg of morphine injection, maternal rest, awoke to resume for more coordination of uterine contraction. In the uterine contraction resume coordination, prohibited use oxytocin. If the above treatment, uncoordinated contractions of not being corrected, or with signs of fetal distress, or with cephalopelvic disproportion said, should be to cesarean section. Without coordination of uterine contraction has been control, but still weak uterine contractions can be used coordination, strengthening weak uterine contractions in the uterine contraction method.
[Etiology:
Multi caused by several factors, the common causes are:
1. Cephalopelvic disproportion that the wrong position or abnormal fetus exposed to disruption of the decline can not keep pace with the lower and uterine cervix, which can not cause reflex contraction of the uterus, resulting in weak secondary uterine contraction.
2. Uterine factors uterine hypoplasia, uterine malformations (such as dual-angle womb), uterine wall bloated (such as twins, macrosomia, excessive amniotic fluid, etc.), the maternal (multipara) uterine muscle fiber degeneration or uterine fibroids, fatigue can cause uterine contractions.
3. Spirit of early maternal factors (primipara) [especially for senior citizens above 35 years old primigravida (elderly primipara)], the spirit of tension over the cerebral cortex dysfunction, sleep less and less labor after eating too much exhaustion can lead weak uterine contractions.
4. Endocrine disorders labor, in maternal estrogen, oxytocin, prostaglandins, such as acetylcholine inadequate secretion of progesterone decreased slowly, and the uterus to reduce the sensitivity of acetylcholine, could affect uterine muscle excited threshold , resulting weak uterine contractions.
5. Effect of the drug on labor after the inappropriate use of large doses of sedatives and analgesics, such as morphine, chlorpromazine, meperidine, phenobarbital, uterine contraction can be curbed.
[Clinical]
In accordance with the period can be divided into primary and secondary two. Primary weak uterine contractions in labor is weak uterine contractions begin, I can not Palace on schedule expansion, the Department could not reveal fetal first time fell, the yield-extended secondary is weak uterine contractions in labor normal uterine contractions begin, but in the birth process to progress a certain stage (or more active in the second stage of labor), the weakening of uterine contraction, the slow progress of labor, even grinds to a halt. Weak uterine contractions There are two types, clinical manifestations are also different.
1. Weak coordination uterine contraction (low-uterine contraction weak) with normal uterine contractions in the rhythm, symmetry and polarity, but contraction is weak, intrauterine pressure low (<2.0 kPa), a short time, intermittent period long without laws, contractions <2 / 10 minutes. When uterine contraction of a period, not uplift and uterus, acting like a finger pressure at the bottom of the Palais muscle wall can appear Depression, middle-extended or stagnation. Tension due to intrauterine low, the effects on the babies do not.
2. Uncoordinated contraction of the uterus weak (high-uterine contraction weak) uterine contractions in the polarity inversion, the contractions began on both sides is not of the uterine horn, the exciting site from the uterine contractions of one or more, the rhythm uncoordinated. Palace at the bottom of contractions is not strong, but the middle section or paragraph under strong contractions intermittent period uterine wall can not completely relax, uncoordinated performance for uterine contraction, such contractions I can not Palace expansion, the child can not be exposed to the Department of decline Contractions are invalid. Maternal consciously under sustained abdominal pain, and rejected by, irritability, dehydration, electrolyte imbalance, intestinal bloating, urinary retention; fetus - placental circulation obstacles, there may be the fetal distress. Inspections: a lower abdominal tenderness, the wrong position to touch unclear, irregular fetal heart rate, dilated cervix slow or expansion, decreased fetal first disclosure of the delay or stagnation, the labor extension.
3. Labor varicose lead to abnormal uterine contraction weak labor curve anomalies, there are seven kinds of the following:
(1) extend the incubation period: from labor laws contractions started to cervical dilatation 3 cm known as latency. Primipara normal incubation period about eight hours, the greatest 16-hour time limit, known as the incubation period is more than 16 hours longer (Figure 1).
Figure 1 Schematic diagram of cervical dilatation incubation period extended
(2) extend the active period: 3 cm dilated cervix I started to open cervix I called the active phase. Primipara active normal about four hours, eight hours maximum time, more than eight hours as active extension (Figure 2).
Figure 2 active extended sketch
(3) active stagnation: Entering the active period, I no longer cervical expansion of more than two hours, known as active stagnation.
(4) second stage of the extension: the beginning of the second stage of maternal more than two hours, the mothers of more than one hour has not yet Wen called the second stage of the extension.
(5) The second stage of stagnation; second stage of fetal head of one hour drop no progress, as the second stage of stagnation.
(6) decreased retard fetal head: Active advanced to the Palais dilatation 9 ~ 10 cm, fetal head rate of decline of less than 1 cm per hour, known as fetal head drop delay.
(7) decreased fetal head stagnation: the fetal head does not stay in the former fell by more than one hour, known as fetal head drop stagnation.
More than seven kinds of abnormal labor progress, can stand alone, there also could be merged. When the birth process called diapause more than 24 hours of production, the need to avoid delay in production.
[Prevention]
Prenatal education to pregnant women, pregnant women thinking of lifting concerns and fear that pregnant women in pregnancy and childbirth is the understanding of physiological processes. Both at home and abroad to set up production recreation room (let wife and family members to accompany) and the family of the wards, contribute to the elimination of maternal stress, boost confidence, can prevent mental stress-induced uterine atony. Childbirth encourage more consumption and, if necessary, from intravenous nutritional supplements. Avoid excessive use of sedative drugs, to check for cephalopelvic disproportion said, is the prevention of uterine contractions and weak effective measures. Pay attention to timely rectum and bladder emptying, if necessary, feasible warm soapy water enema and catheterization.
[Summary]
Including the production of uterine contractility, and the abdominal muscle contraction of the diaphragm muscle and anal contraction, with the main uterine contractility. In the delivery process, uterine contraction of the rhythm, symmetry and not normal polarity or intensity, frequency changes, known as abnormal uterine contractility. Clinical more production, or because of fetal abnormalities form factors obstruction dystocia, the fetus through the birth canal resistance increased, resulting in production of secondary abnormalities. Abnormal uterine contractility of the weak and divided into uterine contractions in the uterine contraction strong two categories, and each category, for the coordination and uncoordinated contraction of the uterus and uterine contraction.
[Treatment]
1. Weak coordination uterine contraction whether primary or secondary, when there is a coordination of uterine contraction weakness, should first look for reasons, whether cephalopelvic disproportion that the wrong position and abnormal fetal and understanding of cervical dilatation first disclosure of the decline situation. If found cephalopelvic disproportion that can not be estimated by vaginal delivery, cesarean section to be timely, if not cephalopelvic disproportion judge said the wrong position and abnormal vaginal delivery can be estimated, should consider measures to strengthen the contractions .
(1) first stage
1) General addressed: the elimination of tension, more breaks to encourage more consumption. Can not eat may intravenous nutritional supplements to Deng 10% glucose 500 to 1000 ml, and vitamin C 2g. Acidosis should be supplemented with 5% sodium bicarbonate. Hypokalemia should be given potassium chloride slow intravenous drip. Maternal fatigue, give stability and the slow intravenous injection of 10 mg or 100 mg intramuscular meperidine, after a period of time, the uterine contractility can be strengthened. On the opening of the cervix primipara less than 3 cm, fetal membranes has not been broken, should be given warm soapy water enema, and promote peristalsis, eliminate waste and Gas, stimulates uterine contractions. Natural urination difficulties, the first induction, should be null and void when catheterization for bladder emptying Road can be widened production, and promote the role of uterine contraction.
2) strengthening the uterine contraction: the normal processing, uterine contractility still weak, confirmed for the coordination of uterine contraction fatigue, no significant progress birth process, the choice of ways to strengthen the contractions:
① artificial rupture of membrane: cervical dilatation 3 cm or more than 3 cm, without cephalopelvic disproportion that the fetal head has been convergence, feasible artificial rupture of membrane. AA, fetal head directly under close of the uterus and cervix, uterus caused reflex contraction accelerating labor progress. Existing scholars advocated fetal head of convergence are also not feasible artificial rupture of membrane that AA can promote fetal head drop Rupen. AA must first check whether the umbilical cord Lu, AA should be carried out in the intermittent contractions. After the rupture of membrane of the fingers should remain in the vagina after 1 or 2 times contractions question fetal head Rupen, then fingers of those removed. Bishop proposed by the score of cervical ripening of the estimated effect of measures to strengthen contractions, as shown in table 1. If maternal and scored three points in the following three minutes, both artificial rupture of membrane failure, should use other methods. 4 to 6 pm the success rate is about 50%, from 7 to 9 pm the success rate is about 80 percent, 9 points above successfully.
Table 1 Bishop cervical maturity score
Index Score
0 1 2 3
Palace opening of the mouth (cm) 0 1 1-2 3-4 5-6
Cervical dissipated (%)
(Not dissipated 2 cm) 0 to 30 40 to 50 60 to 70 80 to 100
First open position
(Ischial spine level = 0) -3 -2 -1 ~ 0 +1 ~ +2
Cervical hardness of soft hardware
I Palace in the former location
② stability (valium) intravenous injection: stability and smooth muscle relaxation can cervix, cervical softening and promote cervical dilatation. Apply to the slow expansion of cervical and cervical edema. Commonly used dose of 10 mg intravenous injection interval of 2 to 6 hours can be repeated applications, combined with the effects of oxytocin better.
③ oxytocin (oxytocin) infusion: applicable to weak coordination of uterine contractions, fetal heart rate good, the wrong position to normal, proportionate to the first pots. U oxytocin 2.5 will be 5% glucose solution 500 ml, so that the sugar content of each droplet oxytocin 0.33 mU from 8 drops / min or 2.5 mU / min, in accordance with contractions strength to adjust, usually not more than 10 mU / min (30 drops / min), the uterine contractions, the pressure of 6.7 ~ 8.0 kPa (50 ~ 60mmHg), contractions between 2 to 3 minutes, continuing 40 to 60 seconds. For non-sensitive, increase oxytocin dose.
Oxytocin infusion process, the person should be observed contractions, fetal heart rate and blood pressure listen. If there contractions continued listening to one minute or more, or there are changes in fetal heart rate, should immediately stop drip. Oxytocin in the blood half-life of the mother for 2 to 3 minutes, can be improved rapidly after treatment, if necessary that could use tranquilizers to contain its role, if high blood pressure should slow down infusion rate. Because oxytocin has been called anti-diuretic effect, the re-absorption of water increased, there will be Niaoshao, to guard against the occurrence of water intoxication.
④ prostaglandin (prostaglandin, PG) Applications: prostaglandin E2 and F2 α have the duty to promote the role of uterine contraction. For the oral route of administration, intravenous and local administration (posterior fornix placed in the vagina). PGE2 intravenous infusion of 0.5 μ g / min and PGF2 α5μ g / min, usually maintaining effective uterine contraction. If half an hour after the contractions still strong, and may, as appropriate, increase the dose, the largest dose of 20 μ g / min. Prostaglandin response to the vice excessive uterine contractions, nausea, vomiting, headache, rapid heart rate, blurred vision and go far in superficial vein, it should be cautiously uses.
⑤ acupuncture points: the effect of strengthening contractions. Acupuncture usually LI4, Sanyinjiao, Taichong, very, Kuan-yuan, and points on the way to stimulate strong, stay needle 20 ~ 30 minutes. Auricular acupuncture optional uterus, sympathetic, endocrine, and other points.
After the treatment, if no progress or labor there signs of fetal distress, to be timely cesarean section.
(2) The second stage: The second stage of the absence of cephalopelvic disproportion, a weak uterine contractions, uterine contraction should also be strengthened, given oxytocin infusion for labor progress. If fetal head biparietal diameter through the ischial spine plane has been waiting for natural childbirth, or visit Episiotomy, to attract fetal head of midwifery or forceps; if not yet convergence or fetal head with signs of fetal distress, should be held cesarean section .
(3) The third stage: for the prevention of post-partum hemorrhage, before fetal shoulder when exposed to the vagina, I can provide a new base lysergic 0.2 mg intravenous injection, and at the same time given oxytocin 10 to 20 U intravenous drip to enhance uterine contractions , and is delivered to the placenta and uterine stripping sinusoids closed. If middle-long AA long time, should be given antibiotics to prevent infection.
2. Uncoordinated contraction of the uterus is the principle of dealing with weak regulation uterine contractions and restore uterine contraction polarity. Given strong sedatives meperidine 100 mg or 10 to 15 mg of morphine injection, maternal rest, awoke to resume for more coordination of uterine contraction. In the uterine contraction resume coordination, prohibited use oxytocin. If the above treatment, uncoordinated contractions of not being corrected, or with signs of fetal distress, or with cephalopelvic disproportion said, should be to cesarean section. Without coordination of uterine contraction has been control, but still weak uterine contractions can be used coordination, strengthening weak uterine contractions in the uterine contraction method.
[Etiology:
Multi caused by several factors, the common causes are:
1. Cephalopelvic disproportion that the wrong position or abnormal fetus exposed to disruption of the decline can not keep pace with the lower and uterine cervix, which can not cause reflex contraction of the uterus, resulting in weak secondary uterine contraction.
2. Uterine factors uterine hypoplasia, uterine malformations (such as dual-angle womb), uterine wall bloated (such as twins, macrosomia, excessive amniotic fluid, etc.), the maternal (multipara) uterine muscle fiber degeneration or uterine fibroids, fatigue can cause uterine contractions.
3. Spirit of early maternal factors (primipara) [especially for senior citizens above 35 years old primigravida (elderly primipara)], the spirit of tension over the cerebral cortex dysfunction, sleep less and less labor after eating too much exhaustion can lead weak uterine contractions.
4. Endocrine disorders labor, in maternal estrogen, oxytocin, prostaglandins, such as acetylcholine inadequate secretion of progesterone decreased slowly, and the uterus to reduce the sensitivity of acetylcholine, could affect uterine muscle excited threshold , resulting weak uterine contractions.
5. Effect of the drug on labor after the inappropriate use of large doses of sedatives and analgesics, such as morphine, chlorpromazine, meperidine, phenobarbital, uterine contraction can be curbed.
[Clinical]
In accordance with the period can be divided into primary and secondary two. Primary weak uterine contractions in labor is weak uterine contractions begin, I can not Palace on schedule expansion, the Department could not reveal fetal first time fell, the yield-extended secondary is weak uterine contractions in labor normal uterine contractions begin, but in the birth process to progress a certain stage (or more active in the second stage of labor), the weakening of uterine contraction, the slow progress of labor, even grinds to a halt. Weak uterine contractions There are two types, clinical manifestations are also different.
1. Weak coordination uterine contraction (low-uterine contraction weak) with normal uterine contractions in the rhythm, symmetry and polarity, but contraction is weak, intrauterine pressure low (<2.0 kPa), a short time, intermittent period long without laws, contractions <2 / 10 minutes. When uterine contraction of a period, not uplift and uterus, acting like a finger pressure at the bottom of the Palais muscle wall can appear Depression, middle-extended or stagnation. Tension due to intrauterine low, the effects on the babies do not.
2. Uncoordinated contraction of the uterus weak (high-uterine contraction weak) uterine contractions in the polarity inversion, the contractions began on both sides is not of the uterine horn, the exciting site from the uterine contractions of one or more, the rhythm uncoordinated. Palace at the bottom of contractions is not strong, but the middle section or paragraph under strong contractions intermittent period uterine wall can not completely relax, uncoordinated performance for uterine contraction, such contractions I can not Palace expansion, the child can not be exposed to the Department of decline Contractions are invalid. Maternal consciously under sustained abdominal pain, and rejected by, irritability, dehydration, electrolyte imbalance, intestinal bloating, urinary retention; fetus - placental circulation obstacles, there may be the fetal distress. Inspections: a lower abdominal tenderness, the wrong position to touch unclear, irregular fetal heart rate, dilated cervix slow or expansion, decreased fetal first disclosure of the delay or stagnation, the labor extension.
3. Labor varicose lead to abnormal uterine contraction weak labor curve anomalies, there are seven kinds of the following:
(1) extend the incubation period: from labor laws contractions started to cervical dilatation 3 cm known as latency. Primipara normal incubation period about eight hours, the greatest 16-hour time limit, known as the incubation period is more than 16 hours longer (Figure 1).
Figure 1 Schematic diagram of cervical dilatation incubation period extended
(2) extend the active period: 3 cm dilated cervix I started to open cervix I called the active phase. Primipara active normal about four hours, eight hours maximum time, more than eight hours as active extension (Figure 2).
Figure 2 active extended sketch
(3) active stagnation: Entering the active period, I no longer cervical expansion of more than two hours, known as active stagnation.
(4) second stage of the extension: the beginning of the second stage of maternal more than two hours, the mothers of more than one hour has not yet Wen called the second stage of the extension.
(5) The second stage of stagnation; second stage of fetal head of one hour drop no progress, as the second stage of stagnation.
(6) decreased retard fetal head: Active advanced to the Palais dilatation 9 ~ 10 cm, fetal head rate of decline of less than 1 cm per hour, known as fetal head drop delay.
(7) decreased fetal head stagnation: the fetal head does not stay in the former fell by more than one hour, known as fetal head drop stagnation.
More than seven kinds of abnormal labor progress, can stand alone, there also could be merged. When the birth process called diapause more than 24 hours of production, the need to avoid delay in production.
[Prevention]
Prenatal education to pregnant women, pregnant women thinking of lifting concerns and fear that pregnant women in pregnancy and childbirth is the understanding of physiological processes. Both at home and abroad to set up production recreation room (let wife and family members to accompany) and the family of the wards, contribute to the elimination of maternal stress, boost confidence, can prevent mental stress-induced uterine atony. Childbirth encourage more consumption and, if necessary, from intravenous nutritional supplements. Avoid excessive use of sedative drugs, to check for cephalopelvic disproportion said, is the prevention of uterine contractions and weak effective measures. Pay attention to timely rectum and bladder emptying, if necessary, feasible warm soapy water enema and catheterization.
Pregnant women with hypertension
Pregnant women with hypertension
[Summary]
Essential hypertension is arterial blood pressure increased for the main clinical manifestations of vascular disease. Cause not yet very clear, but morbidity, and the age-related. My information <20 years of age, the incidence rate was 3.11 percent, 20 to 29 years of age was 3.91% for 30 to 39-year-old 4.95%; increased significantly after the age of 40. Therefore, the leather women of childbearing age, hypertension rare.
[Diagnosis]
Normal blood pressure in different physiological circumstances have a certain fluctuation range, when the anxiety and tension, stress or physical activity, blood pressure can be increased. In addition, the growth of systolic blood pressure increased with age, hypertension and normal blood pressure Therefore, the boundary demarcation difficult. 1979 China revised method of measuring blood pressure and hypertension diagnostic criteria are as follows:
1. Rest after 15 minutes, from sitting right arm blood pressure measurement, the measurement should be repeated several times until the blood pressure values relatively stable. DBP to voice disappeared, is continuing disappear such as voice, audio, using numerical variable. With the one hour interval days, or every other day again verified.
2. Where systolic blood pressure ≥ 21.2 kPa (160mmHg) and (or) diastolic blood pressure ≥ 12.6 kPa (95mmHg), the diagnosis can be verified. 18.7 ~ ~ 21.2/12 blood pressure of 12.6 kPa (140 ~ 160/90 ~ 95mmHg) for the clinical hypertension.
3. Past history of hypertension, not for more than three months, the normal blood pressure checks, not as hypertension; such as drug treatment and this has been normal blood pressure checks, should be diagnosed as hypertension.
Women of childbearing age suffering from hypertension most of the first period, the rare vascular complications, and fundus, electrocardiogram, cardiac, renal function test abnormalities often without, it must be diagnosed based on the only arterial hypertension. First visit as in the second trimester, as peripheral expansion, hemodilution and placenta formation arteriovenous short circuit can 40% of the systolic blood pressure in patients with a decline of 2.7 kPa (20mmHg) due to the diagnosis complicated. First visit that is renal dysfunction, it is difficult to identify chronic glomerulonephritis or chronic pyelonephritis caused symptoms of high blood pressure, or hypertension caused by kidney disease.
[Treatment]
1. Vein thrombosis treatment
(1) General addressed: bed rest 1 to 2 weeks to relieve leg pain, in the vein thrombosis visco-tight wall endometrial until the machine, luminal patency. Chigaohuanshi, higher than the level of cardiopulmonary from bed 20 to 30 cm, knee buckling slightly to facilitate a reduction in venous return edema. Maintain patency stool to prevent forced defecation而使thrombosis loss. Get up and wear long elastic stockings EC 6 to 12 weeks to oppression superficial vein, increase return and reduce lower extremity edema.
(2) thrombolytic therapy: apply to three days after the onset of pulmonary embolism, or concurrent.
1) streptokinase: half an hour before, intravenous hydrocortisone 25 ~ 50 mg of dexamethasone or 5 to 10 mg, to prevent adverse reactions. Early dose of streptokinase 500,000 u plus 5% glucose fluid or 100 ml saline, intravenous infusion within 30 minutes End, after 100,000 u / h to maintain until the symptoms disappear, renewable drop 3 to 4 hours. Can also be used streptokinase 600,000 u hydrogenation of cortisone 25 mg (or dexamethasone 25 mg) plus 5% glucose 250 ~ 500 ml intravenously once every six hours. General for 3 ~ 5.
2) UK: adverse reactions small, without application of adrenocortical hormones. Early dose of 3 ~ 50000 u plus 5% glucose solution (or dextran-40) 250 ~ 500 ml, 1 to 2 hours intravenous infusion End, and 2 to 3 times daily. According to the daily maintenance of the determination of fibrinogen or euglobulin dissolution time adjustments can be连用1 ~ 2 weeks.
3) plasmin: 50,000 to 150,000 u 5% glucose solution of 250 ml, within 30 minutes intravenous drip End. After 50,000 u 5% glucose solution intravenously for 2 to 3 times daily, a total of 7.
4) in the plasma (plasminogen) combined with streptokinase: plasma in the original 90 mg or 120 mg and 150 ml saline, intravenous infusion of 4 to 6 hours, following by streptokinase 600,000 u 100 ml normal saline infusion , 30 minutes drops End, once a day, the linked on the 5th.
(3) dextran -70 or -40 500 to 1000ml dextran, intravenous infusion once a day upto 10 to 14 days to clear the blood vessels.
(4) Surgical treatment: thrombosis or more conservative treatment fails, consider the purposes of deep venous thrombosis extraction, and lower extremity venous ligation.
2. Treatment of pulmonary embolism: with pulmonary embolism, were advised to take the following measures.
(1) Oxygen: to improve arterial oxygen pressure.
(2) pain: chest pain, can be 30 to 60 mg of papaverine hydrochloride or pethidine (meperidine) 50 ~ 100 mg, intramuscular injection, or 5 to 10 mg of morphine, subcutaneous injection.
(3) spasm: 0.5 to 1 mg of atropine, intravenous injection, every one to four hours once a continued downturn nerve resistance, prevent or improve the pulmonary blood vessels and coronary artery reflex spasm. Aminophylline 0.25 ~ 0.5 g 5% glucose 100 to 250 ml, intravenous drip to relieve bronchial spasm.
(4) anti-shock: dopamine 20 ~ 40 mg or 40 mg Alameng 20 ~ 5% glucose solution 200 ml, intravenous drip.
(5) Strong Heart: acetyl hair to spend glycosides (West to Portland), or 0.4 to 0.8 mg Mao spent glycoside toxicity K0.25mg plus 50% glucose solution was injected intravenously.
[Clinical]
In the 20 weeks of pregnancy before repeated measurements of blood pressure in the 18.7/12 kPa (140/90mmHg) above, before or during pregnancy is diagnosed with hypertension, known as the pregnancy with essential hypertension. About 59% of patients have family history.
Pregnant women with hypertension and blood pressure in the second trimester decline, or blood pressure lower than the 21.2/13.3 kPa (160/100mmHg), fetal survival rate of high blood pressure than if 21.2/13.3 kPa (160/100mmHg), fetal mortality increased significantly. Of pregnant women suffer from hypertension, about 10% ~ 20% in late pregnancy with pregnancy-induced hypertension. Based on blood pressure> 24/14.6 kPa (180/110mmHg), fetal mortality rate of 23 percent if additional pregnancy-induced hypertension and, fetal mortality rate as high as 41.3%. Levy appeared earlier pregnancy-induced hypertension, fetal-worse, 32 gestational weeks ago with pregnancy-induced hypertension, 75 percent of intrauterine fetal death. In addition, on the basis of essential hypertension in pregnancy-induced hypertension, the incidence of placental abruption rate of 2%, compared with pregnancy-induced hypertension simply higher.
[Summary]
Essential hypertension is arterial blood pressure increased for the main clinical manifestations of vascular disease. Cause not yet very clear, but morbidity, and the age-related. My information <20 years of age, the incidence rate was 3.11 percent, 20 to 29 years of age was 3.91% for 30 to 39-year-old 4.95%; increased significantly after the age of 40. Therefore, the leather women of childbearing age, hypertension rare.
[Diagnosis]
Normal blood pressure in different physiological circumstances have a certain fluctuation range, when the anxiety and tension, stress or physical activity, blood pressure can be increased. In addition, the growth of systolic blood pressure increased with age, hypertension and normal blood pressure Therefore, the boundary demarcation difficult. 1979 China revised method of measuring blood pressure and hypertension diagnostic criteria are as follows:
1. Rest after 15 minutes, from sitting right arm blood pressure measurement, the measurement should be repeated several times until the blood pressure values relatively stable. DBP to voice disappeared, is continuing disappear such as voice, audio, using numerical variable. With the one hour interval days, or every other day again verified.
2. Where systolic blood pressure ≥ 21.2 kPa (160mmHg) and (or) diastolic blood pressure ≥ 12.6 kPa (95mmHg), the diagnosis can be verified. 18.7 ~ ~ 21.2/12 blood pressure of 12.6 kPa (140 ~ 160/90 ~ 95mmHg) for the clinical hypertension.
3. Past history of hypertension, not for more than three months, the normal blood pressure checks, not as hypertension; such as drug treatment and this has been normal blood pressure checks, should be diagnosed as hypertension.
Women of childbearing age suffering from hypertension most of the first period, the rare vascular complications, and fundus, electrocardiogram, cardiac, renal function test abnormalities often without, it must be diagnosed based on the only arterial hypertension. First visit as in the second trimester, as peripheral expansion, hemodilution and placenta formation arteriovenous short circuit can 40% of the systolic blood pressure in patients with a decline of 2.7 kPa (20mmHg) due to the diagnosis complicated. First visit that is renal dysfunction, it is difficult to identify chronic glomerulonephritis or chronic pyelonephritis caused symptoms of high blood pressure, or hypertension caused by kidney disease.
[Treatment]
1. Vein thrombosis treatment
(1) General addressed: bed rest 1 to 2 weeks to relieve leg pain, in the vein thrombosis visco-tight wall endometrial until the machine, luminal patency. Chigaohuanshi, higher than the level of cardiopulmonary from bed 20 to 30 cm, knee buckling slightly to facilitate a reduction in venous return edema. Maintain patency stool to prevent forced defecation而使thrombosis loss. Get up and wear long elastic stockings EC 6 to 12 weeks to oppression superficial vein, increase return and reduce lower extremity edema.
(2) thrombolytic therapy: apply to three days after the onset of pulmonary embolism, or concurrent.
1) streptokinase: half an hour before, intravenous hydrocortisone 25 ~ 50 mg of dexamethasone or 5 to 10 mg, to prevent adverse reactions. Early dose of streptokinase 500,000 u plus 5% glucose fluid or 100 ml saline, intravenous infusion within 30 minutes End, after 100,000 u / h to maintain until the symptoms disappear, renewable drop 3 to 4 hours. Can also be used streptokinase 600,000 u hydrogenation of cortisone 25 mg (or dexamethasone 25 mg) plus 5% glucose 250 ~ 500 ml intravenously once every six hours. General for 3 ~ 5.
2) UK: adverse reactions small, without application of adrenocortical hormones. Early dose of 3 ~ 50000 u plus 5% glucose solution (or dextran-40) 250 ~ 500 ml, 1 to 2 hours intravenous infusion End, and 2 to 3 times daily. According to the daily maintenance of the determination of fibrinogen or euglobulin dissolution time adjustments can be连用1 ~ 2 weeks.
3) plasmin: 50,000 to 150,000 u 5% glucose solution of 250 ml, within 30 minutes intravenous drip End. After 50,000 u 5% glucose solution intravenously for 2 to 3 times daily, a total of 7.
4) in the plasma (plasminogen) combined with streptokinase: plasma in the original 90 mg or 120 mg and 150 ml saline, intravenous infusion of 4 to 6 hours, following by streptokinase 600,000 u 100 ml normal saline infusion , 30 minutes drops End, once a day, the linked on the 5th.
(3) dextran -70 or -40 500 to 1000ml dextran, intravenous infusion once a day upto 10 to 14 days to clear the blood vessels.
(4) Surgical treatment: thrombosis or more conservative treatment fails, consider the purposes of deep venous thrombosis extraction, and lower extremity venous ligation.
2. Treatment of pulmonary embolism: with pulmonary embolism, were advised to take the following measures.
(1) Oxygen: to improve arterial oxygen pressure.
(2) pain: chest pain, can be 30 to 60 mg of papaverine hydrochloride or pethidine (meperidine) 50 ~ 100 mg, intramuscular injection, or 5 to 10 mg of morphine, subcutaneous injection.
(3) spasm: 0.5 to 1 mg of atropine, intravenous injection, every one to four hours once a continued downturn nerve resistance, prevent or improve the pulmonary blood vessels and coronary artery reflex spasm. Aminophylline 0.25 ~ 0.5 g 5% glucose 100 to 250 ml, intravenous drip to relieve bronchial spasm.
(4) anti-shock: dopamine 20 ~ 40 mg or 40 mg Alameng 20 ~ 5% glucose solution 200 ml, intravenous drip.
(5) Strong Heart: acetyl hair to spend glycosides (West to Portland), or 0.4 to 0.8 mg Mao spent glycoside toxicity K0.25mg plus 50% glucose solution was injected intravenously.
[Clinical]
In the 20 weeks of pregnancy before repeated measurements of blood pressure in the 18.7/12 kPa (140/90mmHg) above, before or during pregnancy is diagnosed with hypertension, known as the pregnancy with essential hypertension. About 59% of patients have family history.
Pregnant women with hypertension and blood pressure in the second trimester decline, or blood pressure lower than the 21.2/13.3 kPa (160/100mmHg), fetal survival rate of high blood pressure than if 21.2/13.3 kPa (160/100mmHg), fetal mortality increased significantly. Of pregnant women suffer from hypertension, about 10% ~ 20% in late pregnancy with pregnancy-induced hypertension. Based on blood pressure> 24/14.6 kPa (180/110mmHg), fetal mortality rate of 23 percent if additional pregnancy-induced hypertension and, fetal mortality rate as high as 41.3%. Levy appeared earlier pregnancy-induced hypertension, fetal-worse, 32 gestational weeks ago with pregnancy-induced hypertension, 75 percent of intrauterine fetal death. In addition, on the basis of essential hypertension in pregnancy-induced hypertension, the incidence of placental abruption rate of 2%, compared with pregnancy-induced hypertension simply higher.
Pregnancy with hyperthyroidism
Pregnancy with hyperthyroidism
[Summary]
Hyperthyroidism (hyperthyroidism) is a common endocrine diseases of the thyroid hormone secretion caused by excessive. Hyperthyroidism women frequently manifests itself menstrual disorders, reduce or amenorrhea, low fertility. But after treatment of hyperthyroidism or untreated women, many also pregnant, the incidence of 1:1000 to 2500 about the pregnancy. Most of hyperthyroidism during pregnancy is Graves disease, which is a largely self-induced immunity and spirit, features diffuse goiter and exophthalmos.
[Diagnosis]
As normal pregnancy maternal thyroid morphology and function of change, and in many respects similar to the clinical manifestation of hyperthyroidism, such as tachycardia, cardiac output increased thyroid increased, warm skin, sweating, fear fever, anorexia, such as hyperthyroidism, Hyperthyroidism in pregnancy and are quite common, so that pregnant women with hyperthyroidism diagnosis has been difficult. In the prenatal examination found that the signs and symptoms of hyperthyroidism, the thyroid gland should be done further to the function of diagnosis. The diagnosis of hyperthyroidism during pregnancy criteria: high metabolic syndrome, serum total thyroxine (TT4) ≥ 180.6 nmol / L (14 μ g / dl), total triiodothyronine (TT3) ≥ 3.54 nmol / L (230ng / dl), free thyroxine index (FT4I) ≥ 12.8. TT4 hyperthyroid condition to the highest level <1.4 times the normal upper limit for those mild hyperthyroidism;> 1.4 times the normal upper limit for the moderate hyperthyroidism; crisis, heart disease and congestive heart failure hyperthyroidism, myopathy, etc. Severe hyperthyroidism.
[Treatment]
(1) Pre-pregnancy: hyperthyroidism due to a series of adverse effects on fetuses such as diagnosis of hyperthyroidism should be stable condition 1 to 3 years after pregnancy properly, medication (anti-thyroid drugs or radioactive iodine), should not be pregnant, should take contraceptive measures.
(2) dealing with pregnancy
1) hyperthyroidism in high-risk pregnant women should check with outpatient follow-up, pay attention to fetal growth, a positive control preeclampsia.
2) mild hyperthyroidism during pregnancy can be tolerated, the light conditions, in general do not have anti-thyroid medication, because of anti-thyroid drugs to fetus through the placenta affect thyroid function. However, severe illness, should continue to use anti-thyroid medication. Pregnancy, the late anti-thyroid drug dose should not be too large, in order to maintain the general level of maternal TT4 not more than 1.4 times the normal upper limit for the degree, but also can be mild hyperthyroidism. > 1.4 times the upper limit of normal when using anti-thyroid drugs. Antithyroid drugs, Propylthiouracil-not only can block thyroid hormone synthesis, and in the surrounding tissue blocking transit T4 into T3 effectiveness of the play, serum T3 levels decline rapidly. Common dose Propylthiouracil-150 ~ 300 mg / d, or tapazole 15 ~ 30 mg / d, hyperthyroidism can gradually reduce control. In the pre-production period of 2 to 3 weeks ago did not medication, or use of the minimum effective control of hyperthyroidism. Propylthiouracil-maintained in the amount of 200 mg per day below tapazole 20 mg below, the possibility of fetal goiter occurred minimal. For in the application of anti-thyroid drugs in the treatment of thyroid hormone increases with the problem of controversy, not because of thyroid hormone through the placenta, but increased use of anti-thyroid drug dose, but can be combined to eliminate anti-thyroid drug-induced hypothyroidism and the prevention of fetal due to the impact of anti-thyroid drugs in hypothyroidism or goiter.
3) The anti-thyroid drugs can rapidly fetus through the placenta affect thyroid function, it was argued that the anti-thyroid drug therapy later, underwent total thyroidectomy, and achieved good results, but the general view was that pregnancy should be avoided thyroidectomy because of pregnancy Hyperthyroidism surgery more difficult period, after the mother-merger hypothyroidism, hypoparathyroidism and recurrent laryngeal nerve injury, and surgery induce miscarriages and premature.
4) β-blocker propranolol (Inderal) the application of 10 ~ 20 mg dose three times daily. Propranolol hyperthyroidism pregnant women is an effective therapeutic drugs, to ease due to excessive thyroid hormone caused by systemic symptoms. Propranolol role faster, better results, applicable to hyperthyroidism crisis and implementation of emergency preparations for the rapid thyroid surgery. However, β-blockers, or heart failure in the early metabolic acidosis in patients with acute heart failure will lead to, under general anesthesia can cause severe hypotension, long-term use of propranolol can increase uterine muscle tone, leading to development of the placenta bad, and intrauterine growth retardation, it was not in hyperthyroidism during pregnancy as the preferred drug.
5) Obstetric Care: pregnancy with hyperthyroidism, appropriate treatment, full-term pregnancy can be reached by vaginal delivery and access live births. Hyperthyroidism cesarean section is not the indication, pregnant women with severe hyperthyroidism, prematurity and perinatal infant mortality high, and intrauterine growth retardation may be, it hyperthyroidism during pregnancy to strengthen observation and control, regular follow-up fetus placental function and prevent premature.
6) puerperium treatment: after a recurrence of hyperthyroidism tendency to increase postpartum anti-thyroid drug dose. Breastfeeding on postpartum Although the issue of anti-thyroid drugs will be affected by infant milk thyroid function, but we believe that a combination of the severity of the maternal illness, as well as taking anti-thyroid drug dose to consider whether breast-feeding.
7) the treatment of hyperthyroidism Crisis: uncontrolled hyperthyroidism during pregnancy and stop anti-thyroid medication, surgery and post-natal visit obstetric postpartum bleeding and infection-induced hyperthyroidism crisis will be, if not timely treatment can occur high fever, tachycardia , heart failure, absence, coma. Should be given a large number of anti-thyroid drugs, such as methyl or propyl AECA, each 100 to 200 mg orally once every six hours; tapazole or hyperthyroidism-10 ~ 20 mg orally once every six hours. Thought to be oral, can be injected into the nasal feeding tube. Oral compound iodine solution, drops about 30 daily. Propranolol 20 ~ 40 mg every 4 to 6 hours a oral, or 0.5 to 1 mg intravenous injection, when the attention of cardiac function. Reserpine 1 ~ 2 mg, intramuscular injection, once every six hours. Hydrocortisone 200 ~ 400 mg daily, intravenous drip and to be broad-spectrum antibiotics, oxygen, cooling and sedation antipyretic agent, correct water and electrolyte imbalance and heart failure.
8) Neonatal Management: pregnant women to give birth on neonatal hyperthyroidism, should pay attention to check for hypothyroidism, goiter or hyperthyroidism, and thyroid function tests.
Maternal TSH, T4 and T3 difficult to pass the placenta barrier, but the long-term thyroid-stimulating hormone (LATS) very easily through the placenta barrier, suffering from hyperthyroidism mother to the possibility of a newborn baby hyperthyroidism, which can be apparent newborns exophthalmos and signs of hyperthyroidism, the umbilical cord blood of T4 and TSH concentration valuation newborn thyroid function. Neonatal hyperthyroidism may appear immediately after birth, or one week away. Neonatal hyperthyroidism treatment, including daily tapazole 0.5 to 1 mg / kg, or Propylthiouracil-daily 5 to 10 mg / kg, at times taking, plus compound iodine solution, each a dripping, three times a day; of heart failure, digitalis, excited to apply sedatives.
Pregnant mothers who have taken anti-thyroid drug, likely to be temporary neonatal hypothyroidism should be addressed.
[Clinical]
As normal pregnancy maternal thyroid morphology and function of change, and in many respects similar to the clinical manifestation of hyperthyroidism, such as tachycardia, cardiac output increased thyroid increased, warm skin, sweating, fear fever, anorexia, such as hyperthyroidism, Hyperthyroidism in pregnancy and are quite common.
Mild hyperthyroidism had no effect on pregnancy, but the severe symptoms of hyperthyroidism, as well as control of the abortion rate, the incidence of preeclampsia, premature birth rate, and term Xiaoyanger incidence of perinatal mortality increased. Hyperthyroidism causes of the impact of pregnancy is not clear, may be due to hyperthyroidism to excessive consumption of nutritional elements, as well as the high incidence of pregnancy-induced hypertension, and the impact caused by placental function.
By the placenta during pregnancy barriers, only a small amount of T3, T4 through the placenta, it will not cause neonatal hyperthyroidism. Hyperthyroidism little effect on pregnancy on the contrary, pregnancy often cause hyperthyroidism condition have varying degrees of ease. But pregnancy with severe hyperthyroidism, pregnancy may increase the burden of the heart, and increased heart disease patients with hyperthyroidism original variable. Individual patients due to childbirth, postpartum bleeding, infection can be induced hyperthyroidism crisis.
[Summary]
Hyperthyroidism (hyperthyroidism) is a common endocrine diseases of the thyroid hormone secretion caused by excessive. Hyperthyroidism women frequently manifests itself menstrual disorders, reduce or amenorrhea, low fertility. But after treatment of hyperthyroidism or untreated women, many also pregnant, the incidence of 1:1000 to 2500 about the pregnancy. Most of hyperthyroidism during pregnancy is Graves disease, which is a largely self-induced immunity and spirit, features diffuse goiter and exophthalmos.
[Diagnosis]
As normal pregnancy maternal thyroid morphology and function of change, and in many respects similar to the clinical manifestation of hyperthyroidism, such as tachycardia, cardiac output increased thyroid increased, warm skin, sweating, fear fever, anorexia, such as hyperthyroidism, Hyperthyroidism in pregnancy and are quite common, so that pregnant women with hyperthyroidism diagnosis has been difficult. In the prenatal examination found that the signs and symptoms of hyperthyroidism, the thyroid gland should be done further to the function of diagnosis. The diagnosis of hyperthyroidism during pregnancy criteria: high metabolic syndrome, serum total thyroxine (TT4) ≥ 180.6 nmol / L (14 μ g / dl), total triiodothyronine (TT3) ≥ 3.54 nmol / L (230ng / dl), free thyroxine index (FT4I) ≥ 12.8. TT4 hyperthyroid condition to the highest level <1.4 times the normal upper limit for those mild hyperthyroidism;> 1.4 times the normal upper limit for the moderate hyperthyroidism; crisis, heart disease and congestive heart failure hyperthyroidism, myopathy, etc. Severe hyperthyroidism.
[Treatment]
(1) Pre-pregnancy: hyperthyroidism due to a series of adverse effects on fetuses such as diagnosis of hyperthyroidism should be stable condition 1 to 3 years after pregnancy properly, medication (anti-thyroid drugs or radioactive iodine), should not be pregnant, should take contraceptive measures.
(2) dealing with pregnancy
1) hyperthyroidism in high-risk pregnant women should check with outpatient follow-up, pay attention to fetal growth, a positive control preeclampsia.
2) mild hyperthyroidism during pregnancy can be tolerated, the light conditions, in general do not have anti-thyroid medication, because of anti-thyroid drugs to fetus through the placenta affect thyroid function. However, severe illness, should continue to use anti-thyroid medication. Pregnancy, the late anti-thyroid drug dose should not be too large, in order to maintain the general level of maternal TT4 not more than 1.4 times the normal upper limit for the degree, but also can be mild hyperthyroidism. > 1.4 times the upper limit of normal when using anti-thyroid drugs. Antithyroid drugs, Propylthiouracil-not only can block thyroid hormone synthesis, and in the surrounding tissue blocking transit T4 into T3 effectiveness of the play, serum T3 levels decline rapidly. Common dose Propylthiouracil-150 ~ 300 mg / d, or tapazole 15 ~ 30 mg / d, hyperthyroidism can gradually reduce control. In the pre-production period of 2 to 3 weeks ago did not medication, or use of the minimum effective control of hyperthyroidism. Propylthiouracil-maintained in the amount of 200 mg per day below tapazole 20 mg below, the possibility of fetal goiter occurred minimal. For in the application of anti-thyroid drugs in the treatment of thyroid hormone increases with the problem of controversy, not because of thyroid hormone through the placenta, but increased use of anti-thyroid drug dose, but can be combined to eliminate anti-thyroid drug-induced hypothyroidism and the prevention of fetal due to the impact of anti-thyroid drugs in hypothyroidism or goiter.
3) The anti-thyroid drugs can rapidly fetus through the placenta affect thyroid function, it was argued that the anti-thyroid drug therapy later, underwent total thyroidectomy, and achieved good results, but the general view was that pregnancy should be avoided thyroidectomy because of pregnancy Hyperthyroidism surgery more difficult period, after the mother-merger hypothyroidism, hypoparathyroidism and recurrent laryngeal nerve injury, and surgery induce miscarriages and premature.
4) β-blocker propranolol (Inderal) the application of 10 ~ 20 mg dose three times daily. Propranolol hyperthyroidism pregnant women is an effective therapeutic drugs, to ease due to excessive thyroid hormone caused by systemic symptoms. Propranolol role faster, better results, applicable to hyperthyroidism crisis and implementation of emergency preparations for the rapid thyroid surgery. However, β-blockers, or heart failure in the early metabolic acidosis in patients with acute heart failure will lead to, under general anesthesia can cause severe hypotension, long-term use of propranolol can increase uterine muscle tone, leading to development of the placenta bad, and intrauterine growth retardation, it was not in hyperthyroidism during pregnancy as the preferred drug.
5) Obstetric Care: pregnancy with hyperthyroidism, appropriate treatment, full-term pregnancy can be reached by vaginal delivery and access live births. Hyperthyroidism cesarean section is not the indication, pregnant women with severe hyperthyroidism, prematurity and perinatal infant mortality high, and intrauterine growth retardation may be, it hyperthyroidism during pregnancy to strengthen observation and control, regular follow-up fetus placental function and prevent premature.
6) puerperium treatment: after a recurrence of hyperthyroidism tendency to increase postpartum anti-thyroid drug dose. Breastfeeding on postpartum Although the issue of anti-thyroid drugs will be affected by infant milk thyroid function, but we believe that a combination of the severity of the maternal illness, as well as taking anti-thyroid drug dose to consider whether breast-feeding.
7) the treatment of hyperthyroidism Crisis: uncontrolled hyperthyroidism during pregnancy and stop anti-thyroid medication, surgery and post-natal visit obstetric postpartum bleeding and infection-induced hyperthyroidism crisis will be, if not timely treatment can occur high fever, tachycardia , heart failure, absence, coma. Should be given a large number of anti-thyroid drugs, such as methyl or propyl AECA, each 100 to 200 mg orally once every six hours; tapazole or hyperthyroidism-10 ~ 20 mg orally once every six hours. Thought to be oral, can be injected into the nasal feeding tube. Oral compound iodine solution, drops about 30 daily. Propranolol 20 ~ 40 mg every 4 to 6 hours a oral, or 0.5 to 1 mg intravenous injection, when the attention of cardiac function. Reserpine 1 ~ 2 mg, intramuscular injection, once every six hours. Hydrocortisone 200 ~ 400 mg daily, intravenous drip and to be broad-spectrum antibiotics, oxygen, cooling and sedation antipyretic agent, correct water and electrolyte imbalance and heart failure.
8) Neonatal Management: pregnant women to give birth on neonatal hyperthyroidism, should pay attention to check for hypothyroidism, goiter or hyperthyroidism, and thyroid function tests.
Maternal TSH, T4 and T3 difficult to pass the placenta barrier, but the long-term thyroid-stimulating hormone (LATS) very easily through the placenta barrier, suffering from hyperthyroidism mother to the possibility of a newborn baby hyperthyroidism, which can be apparent newborns exophthalmos and signs of hyperthyroidism, the umbilical cord blood of T4 and TSH concentration valuation newborn thyroid function. Neonatal hyperthyroidism may appear immediately after birth, or one week away. Neonatal hyperthyroidism treatment, including daily tapazole 0.5 to 1 mg / kg, or Propylthiouracil-daily 5 to 10 mg / kg, at times taking, plus compound iodine solution, each a dripping, three times a day; of heart failure, digitalis, excited to apply sedatives.
Pregnant mothers who have taken anti-thyroid drug, likely to be temporary neonatal hypothyroidism should be addressed.
[Clinical]
As normal pregnancy maternal thyroid morphology and function of change, and in many respects similar to the clinical manifestation of hyperthyroidism, such as tachycardia, cardiac output increased thyroid increased, warm skin, sweating, fear fever, anorexia, such as hyperthyroidism, Hyperthyroidism in pregnancy and are quite common.
Mild hyperthyroidism had no effect on pregnancy, but the severe symptoms of hyperthyroidism, as well as control of the abortion rate, the incidence of preeclampsia, premature birth rate, and term Xiaoyanger incidence of perinatal mortality increased. Hyperthyroidism causes of the impact of pregnancy is not clear, may be due to hyperthyroidism to excessive consumption of nutritional elements, as well as the high incidence of pregnancy-induced hypertension, and the impact caused by placental function.
By the placenta during pregnancy barriers, only a small amount of T3, T4 through the placenta, it will not cause neonatal hyperthyroidism. Hyperthyroidism little effect on pregnancy on the contrary, pregnancy often cause hyperthyroidism condition have varying degrees of ease. But pregnancy with severe hyperthyroidism, pregnancy may increase the burden of the heart, and increased heart disease patients with hyperthyroidism original variable. Individual patients due to childbirth, postpartum bleeding, infection can be induced hyperthyroidism crisis.
Pregnancy with tuberculosis
Pregnancy with tuberculosis
[Summary]
Although pregnancy with tuberculosis in recent years has been in less developed countries, but in developing countries is not uncommon. Appear in the anti-TB drugs, tuberculosis both pregnant women and children, babies have adverse effects, but since the 1970s, due to the development of anti-TB drugs, the patients with pulmonary tuberculosis during pregnancy can have good effect, the pregnancy has not pulmonary tuberculosis become a serious problem.
[Diagnosis]
If pregnant women have low heat, suffering from weight loss, fatigue, night sweats and other symptoms, should attach importance to find out the reasons to exclude the possibility of tuberculosis, and to chest radiography and sputum acid-fast bacilli seized a clear diagnosis.
[Treatment]
1. Strengthen prenatal care: in the majority of patients have been diagnosed before pregnancy and timely treatment, may be a good pregnancy outcomes, such as health education and the importance of prenatal care is not universal attention, individual patients with severe tuberculosis, adverse pregnancy can occur consequences.
2. Disseminated tuberculosis hollow fiber or untreated, shall be in the 6 to 8 weeks pregnant, abortions after trip, were treated in stable condition after pregnancy.
3. Drug treatment: Application of pregnancy has not in favor of streptomycin. Dnider such as that in 1980, 206 cases of pregnancy in the application of streptomycin in the treatment of patients with pulmonary tuberculosis, there were 34 infant cases of acoustic neuroma involvement leaving or complete loss of hearing loss, can no longer use during pregnancy streptomycin treatment.
TB during pregnancy to the first-line drugs isoniazid (INH), ethambutol, such as the addition of vitamin B6 can be used to prevent fetal INH potential neurotoxicity, and ethambutol INH in the first period of the pregnancy drug . While the second line drugs rifampin, ammonia or thiourea mainly kanamycin. Rifampicin in 16 weeks pregnant after the use of more security. Drug treatment for the disease under control, and then continue to apply 1 to 1.5 years. For accompanied by high fever, toxic symptoms of patients, can be used for ammonia acid 12 g increase in 5% glucose solution in 500 ml daily intravenous infusion, continuous 1 to 2 months; condition to be improved, then use a joint anti-TB drugs treatment.
4. Obstetric treatment
(1) dealing with pregnancy: pregnancy can be any condition, anti-TB treatment and prenatal care must be at the same time. Serious TB patients should be in nursing homes or home health care for pregnant women to inspection, with special attention to the spirit of comfort and encouragement eliminate ideological burden, enabling the prevention of pregnancy-related complications such as hypertension.
(2) delivery of treatment: labor began to pay more attention to energy supply and rest, to prevent inadequate supply of heat or mental tension caused by uterine atony. The second stage of forceps or more to attract fetal head of midwifery, so as to avoid excessive fatigue condition to increase. For cesarean section, epidural anesthesia for both properly. Postpartum hemorrhage attention infection.
(3) puerperium treatment: maternal for the activity pulmonary tuberculosis, must be extended rest and continued to increase anti-tuberculosis treatment and nutrition, and active control puerperal infection. With the mother and newborn should be isolated, and promptly vaccinated against tuberculosis. If the maternal disseminated tuberculosis patients, their infants required INH daily 15 ~ 20 mg / kg, in a sustained if tuberculin skin test and chest radiograph were negative, BCG can be used if the skin test positive and negative chest radiograph , then following with INH1; such as skin tests and chest radiograph were positive, then plus his anti-TB drugs.
It should be noted that if the event postpartum unexplained fever, intrauterine infection can not be explained, they should consider whether it is the spread of tuberculosis lesions should be further to chest radiography inspection, definite diagnosis.
[Clinical]
Patients with active tuberculosis, especially more extensive lesions in patients with severe, pregnancy and childbirth can to tuberculosis situation deteriorated, especially severe and not anti-tuberculosis treatment untried pregnant women without prenatal care, pregnancy and childbirth will exacerbate illness substantial (or) died. Active tuberculosis, such as blood disseminated tuberculosis, chronic pulmonary tuberculosis in patients with type hollow fibers such as pregnancy, while the condition may worsen further.
From tuberculosis to look at the impact of pregnancy, particularly in patients with severe chronic illness can be caused by hypoxia, stillbirth or premature increase in the incidence. But in any case, since the 1970s, since the progress of anti-TB drugs, where the active treatment, the prognosis for maternal and child in the past, has been markedly improved.
[Summary]
Although pregnancy with tuberculosis in recent years has been in less developed countries, but in developing countries is not uncommon. Appear in the anti-TB drugs, tuberculosis both pregnant women and children, babies have adverse effects, but since the 1970s, due to the development of anti-TB drugs, the patients with pulmonary tuberculosis during pregnancy can have good effect, the pregnancy has not pulmonary tuberculosis become a serious problem.
[Diagnosis]
If pregnant women have low heat, suffering from weight loss, fatigue, night sweats and other symptoms, should attach importance to find out the reasons to exclude the possibility of tuberculosis, and to chest radiography and sputum acid-fast bacilli seized a clear diagnosis.
[Treatment]
1. Strengthen prenatal care: in the majority of patients have been diagnosed before pregnancy and timely treatment, may be a good pregnancy outcomes, such as health education and the importance of prenatal care is not universal attention, individual patients with severe tuberculosis, adverse pregnancy can occur consequences.
2. Disseminated tuberculosis hollow fiber or untreated, shall be in the 6 to 8 weeks pregnant, abortions after trip, were treated in stable condition after pregnancy.
3. Drug treatment: Application of pregnancy has not in favor of streptomycin. Dnider such as that in 1980, 206 cases of pregnancy in the application of streptomycin in the treatment of patients with pulmonary tuberculosis, there were 34 infant cases of acoustic neuroma involvement leaving or complete loss of hearing loss, can no longer use during pregnancy streptomycin treatment.
TB during pregnancy to the first-line drugs isoniazid (INH), ethambutol, such as the addition of vitamin B6 can be used to prevent fetal INH potential neurotoxicity, and ethambutol INH in the first period of the pregnancy drug . While the second line drugs rifampin, ammonia or thiourea mainly kanamycin. Rifampicin in 16 weeks pregnant after the use of more security. Drug treatment for the disease under control, and then continue to apply 1 to 1.5 years. For accompanied by high fever, toxic symptoms of patients, can be used for ammonia acid 12 g increase in 5% glucose solution in 500 ml daily intravenous infusion, continuous 1 to 2 months; condition to be improved, then use a joint anti-TB drugs treatment.
4. Obstetric treatment
(1) dealing with pregnancy: pregnancy can be any condition, anti-TB treatment and prenatal care must be at the same time. Serious TB patients should be in nursing homes or home health care for pregnant women to inspection, with special attention to the spirit of comfort and encouragement eliminate ideological burden, enabling the prevention of pregnancy-related complications such as hypertension.
(2) delivery of treatment: labor began to pay more attention to energy supply and rest, to prevent inadequate supply of heat or mental tension caused by uterine atony. The second stage of forceps or more to attract fetal head of midwifery, so as to avoid excessive fatigue condition to increase. For cesarean section, epidural anesthesia for both properly. Postpartum hemorrhage attention infection.
(3) puerperium treatment: maternal for the activity pulmonary tuberculosis, must be extended rest and continued to increase anti-tuberculosis treatment and nutrition, and active control puerperal infection. With the mother and newborn should be isolated, and promptly vaccinated against tuberculosis. If the maternal disseminated tuberculosis patients, their infants required INH daily 15 ~ 20 mg / kg, in a sustained if tuberculin skin test and chest radiograph were negative, BCG can be used if the skin test positive and negative chest radiograph , then following with INH1; such as skin tests and chest radiograph were positive, then plus his anti-TB drugs.
It should be noted that if the event postpartum unexplained fever, intrauterine infection can not be explained, they should consider whether it is the spread of tuberculosis lesions should be further to chest radiography inspection, definite diagnosis.
[Clinical]
Patients with active tuberculosis, especially more extensive lesions in patients with severe, pregnancy and childbirth can to tuberculosis situation deteriorated, especially severe and not anti-tuberculosis treatment untried pregnant women without prenatal care, pregnancy and childbirth will exacerbate illness substantial (or) died. Active tuberculosis, such as blood disseminated tuberculosis, chronic pulmonary tuberculosis in patients with type hollow fibers such as pregnancy, while the condition may worsen further.
From tuberculosis to look at the impact of pregnancy, particularly in patients with severe chronic illness can be caused by hypoxia, stillbirth or premature increase in the incidence. But in any case, since the 1970s, since the progress of anti-TB drugs, where the active treatment, the prognosis for maternal and child in the past, has been markedly improved.
Pregnancy with tuberculosis
Pregnancy with tuberculosis
[Summary]
Although pregnancy with tuberculosis in recent years has been in less developed countries, but in developing countries is not uncommon. Appear in the anti-TB drugs, tuberculosis both pregnant women and children, babies have adverse effects, but since the 1970s, due to the development of anti-TB drugs, the patients with pulmonary tuberculosis during pregnancy can have good effect, the pregnancy has not pulmonary tuberculosis become a serious problem.
[Diagnosis]
If pregnant women have low heat, suffering from weight loss, fatigue, night sweats and other symptoms, should attach importance to find out the reasons to exclude the possibility of tuberculosis, and to chest radiography and sputum acid-fast bacilli seized a clear diagnosis.
[Treatment]
1. Strengthen prenatal care: in the majority of patients have been diagnosed before pregnancy and timely treatment, may be a good pregnancy outcomes, such as health education and the importance of prenatal care is not universal attention, individual patients with severe tuberculosis, adverse pregnancy can occur consequences.
2. Disseminated tuberculosis hollow fiber or untreated, shall be in the 6 to 8 weeks pregnant, abortions after trip, were treated in stable condition after pregnancy.
3. Drug treatment: Application of pregnancy has not in favor of streptomycin. Dnider such as that in 1980, 206 cases of pregnancy in the application of streptomycin in the treatment of patients with pulmonary tuberculosis, there were 34 infant cases of acoustic neuroma involvement leaving or complete loss of hearing loss, can no longer use during pregnancy streptomycin treatment.
TB during pregnancy to the first-line drugs isoniazid (INH), ethambutol, such as the addition of vitamin B6 can be used to prevent fetal INH potential neurotoxicity, and ethambutol INH in the first period of the pregnancy drug . While the second line drugs rifampin, ammonia or thiourea mainly kanamycin. Rifampicin in 16 weeks pregnant after the use of more security. Drug treatment for the disease under control, and then continue to apply 1 to 1.5 years. For accompanied by high fever, toxic symptoms of patients, can be used for ammonia acid 12 g increase in 5% glucose solution in 500 ml daily intravenous infusion, continuous 1 to 2 months; condition to be improved, then use a joint anti-TB drugs treatment.
4. Obstetric treatment
(1) dealing with pregnancy: pregnancy can be any condition, anti-TB treatment and prenatal care must be at the same time. Serious TB patients should be in nursing homes or home health care for pregnant women to inspection, with special attention to the spirit of comfort and encouragement eliminate ideological burden, enabling the prevention of pregnancy-related complications such as hypertension.
(2) delivery of treatment: labor began to pay more attention to energy supply and rest, to prevent inadequate supply of heat or mental tension caused by uterine atony. The second stage of forceps or more to attract fetal head of midwifery, so as to avoid excessive fatigue condition to increase. For cesarean section, epidural anesthesia for both properly. Postpartum hemorrhage attention infection.
(3) puerperium treatment: maternal for the activity pulmonary tuberculosis, must be extended rest and continued to increase anti-tuberculosis treatment and nutrition, and active control puerperal infection. With the mother and newborn should be isolated, and promptly vaccinated against tuberculosis. If the maternal disseminated tuberculosis patients, their infants required INH daily 15 ~ 20 mg / kg, in a sustained if tuberculin skin test and chest radiograph were negative, BCG can be used if the skin test positive and negative chest radiograph , then following with INH1; such as skin tests and chest radiograph were positive, then plus his anti-TB drugs.
It should be noted that if the event postpartum unexplained fever, intrauterine infection can not be explained, they should consider whether it is the spread of tuberculosis lesions should be further to chest radiography inspection, definite diagnosis.
[Clinical]
Patients with active tuberculosis, especially more extensive lesions in patients with severe, pregnancy and childbirth can to tuberculosis situation deteriorated, especially severe and not anti-tuberculosis treatment untried pregnant women without prenatal care, pregnancy and childbirth will exacerbate illness substantial (or) died. Active tuberculosis, such as blood disseminated tuberculosis, chronic pulmonary tuberculosis in patients with type hollow fibers such as pregnancy, while the condition may worsen further.
From tuberculosis to look at the impact of pregnancy, particularly in patients with severe chronic illness can be caused by hypoxia, stillbirth or premature increase in the incidence. But in any case, since the 1970s, since the progress of anti-TB drugs, where the active treatment, the prognosis for maternal and child in the past, has been markedly improved.
[Summary]
Although pregnancy with tuberculosis in recent years has been in less developed countries, but in developing countries is not uncommon. Appear in the anti-TB drugs, tuberculosis both pregnant women and children, babies have adverse effects, but since the 1970s, due to the development of anti-TB drugs, the patients with pulmonary tuberculosis during pregnancy can have good effect, the pregnancy has not pulmonary tuberculosis become a serious problem.
[Diagnosis]
If pregnant women have low heat, suffering from weight loss, fatigue, night sweats and other symptoms, should attach importance to find out the reasons to exclude the possibility of tuberculosis, and to chest radiography and sputum acid-fast bacilli seized a clear diagnosis.
[Treatment]
1. Strengthen prenatal care: in the majority of patients have been diagnosed before pregnancy and timely treatment, may be a good pregnancy outcomes, such as health education and the importance of prenatal care is not universal attention, individual patients with severe tuberculosis, adverse pregnancy can occur consequences.
2. Disseminated tuberculosis hollow fiber or untreated, shall be in the 6 to 8 weeks pregnant, abortions after trip, were treated in stable condition after pregnancy.
3. Drug treatment: Application of pregnancy has not in favor of streptomycin. Dnider such as that in 1980, 206 cases of pregnancy in the application of streptomycin in the treatment of patients with pulmonary tuberculosis, there were 34 infant cases of acoustic neuroma involvement leaving or complete loss of hearing loss, can no longer use during pregnancy streptomycin treatment.
TB during pregnancy to the first-line drugs isoniazid (INH), ethambutol, such as the addition of vitamin B6 can be used to prevent fetal INH potential neurotoxicity, and ethambutol INH in the first period of the pregnancy drug . While the second line drugs rifampin, ammonia or thiourea mainly kanamycin. Rifampicin in 16 weeks pregnant after the use of more security. Drug treatment for the disease under control, and then continue to apply 1 to 1.5 years. For accompanied by high fever, toxic symptoms of patients, can be used for ammonia acid 12 g increase in 5% glucose solution in 500 ml daily intravenous infusion, continuous 1 to 2 months; condition to be improved, then use a joint anti-TB drugs treatment.
4. Obstetric treatment
(1) dealing with pregnancy: pregnancy can be any condition, anti-TB treatment and prenatal care must be at the same time. Serious TB patients should be in nursing homes or home health care for pregnant women to inspection, with special attention to the spirit of comfort and encouragement eliminate ideological burden, enabling the prevention of pregnancy-related complications such as hypertension.
(2) delivery of treatment: labor began to pay more attention to energy supply and rest, to prevent inadequate supply of heat or mental tension caused by uterine atony. The second stage of forceps or more to attract fetal head of midwifery, so as to avoid excessive fatigue condition to increase. For cesarean section, epidural anesthesia for both properly. Postpartum hemorrhage attention infection.
(3) puerperium treatment: maternal for the activity pulmonary tuberculosis, must be extended rest and continued to increase anti-tuberculosis treatment and nutrition, and active control puerperal infection. With the mother and newborn should be isolated, and promptly vaccinated against tuberculosis. If the maternal disseminated tuberculosis patients, their infants required INH daily 15 ~ 20 mg / kg, in a sustained if tuberculin skin test and chest radiograph were negative, BCG can be used if the skin test positive and negative chest radiograph , then following with INH1; such as skin tests and chest radiograph were positive, then plus his anti-TB drugs.
It should be noted that if the event postpartum unexplained fever, intrauterine infection can not be explained, they should consider whether it is the spread of tuberculosis lesions should be further to chest radiography inspection, definite diagnosis.
[Clinical]
Patients with active tuberculosis, especially more extensive lesions in patients with severe, pregnancy and childbirth can to tuberculosis situation deteriorated, especially severe and not anti-tuberculosis treatment untried pregnant women without prenatal care, pregnancy and childbirth will exacerbate illness substantial (or) died. Active tuberculosis, such as blood disseminated tuberculosis, chronic pulmonary tuberculosis in patients with type hollow fibers such as pregnancy, while the condition may worsen further.
From tuberculosis to look at the impact of pregnancy, particularly in patients with severe chronic illness can be caused by hypoxia, stillbirth or premature increase in the incidence. But in any case, since the 1970s, since the progress of anti-TB drugs, where the active treatment, the prognosis for maternal and child in the past, has been markedly improved.
Heart disease during pregnancy
Heart disease during pregnancy
[Summary]
Pregnancy heart disease can be divided into two broad categories. The first category is pre-existing heart disease, rheumatic and congenital heart disease in the majority, hypertensive heart disease, mitral valve prolapse and hypertrophic heart disease rare. The second type of heart disease induced by pregnancy, such as preeclampsia heart disease, perinatal heart.
[Diagnosis]
If pre-pregnancy with organic heart disease that is known, of course, there is no diagnosis, but some patients may not seek medical treatment without symptoms. Pregnancy caused by a series of changes in the function of the cardiovascular system, and can lead to palpitation, dyspnea and edema, and other symptoms, but also may be associated with increased heart mild heart murmur and signs, such as X-ray, electrocardiogram changes, thereby increasing cardiac diagnosis difficult. However, if the abnormality found the following should be taken into account the existence of organic heart disease.
1. Ⅲ level and above, the rough systolic murmur.
2. Diastolic murmur.
3. Serious arrhythmia, such as atrial fibrillation or flutter, such as atrioventricular block.
4.X line X-ray film showed a marked widening of cardiac image, especially individual atrial or ventricular expanded significantly.
5. Echocardiography showed heart valve, atrial and ventricular lesions.
[Treatment]
Heart monitor pregnant women
1. Termination of pregnancy indications: Can the original heart of women tolerance pregnancy, the original decision to a number of factors, such as the types of heart disease, diseases of the heart condition and whether complications. Pregnant women in the assessment of heart disease tolerance pregnancy capacity, not only need to consider carefully thought pregnancy may increase the burden on the heart and life-threatening, but also avoid excessive concern, which will rise to the loss of reproductive opportunities. Where any of the following, generally not suitable for pregnancy, early termination: ① heavier heart attack, heart function Ⅲ level and above, or had history of heart failure; ② rheumatic heart disease with pulmonary hypertension, chronic atrial fibrillation and a high degree atrioventricular resistance hysteresis, or the near future with bacterial endocarditis; ③ first obviously cyanotic congenital heart disease or pulmonary hypertension; ④ merger other more serious diseases such as nephritis, severe hypertension, tuberculosis. But if pregnancy has been more than three months, does not generally consider terminating the pregnancy, because of the sick heart, the termination of pregnancy at risk of not less than continue their pregnancy. Such as congestive heart failure has occurred, the timely termination of pregnancy is still suitable.
2. Continue to pregnancy care: heart failure is fatal heart attack pregnant women, but because heart plasma load capacity and the increase in consumption has been declaration to increase the physiological changes and decompensated heart failure caused dysfunction and the key elements. Therefore, the strengthening of pregnancy care aimed at preventing heart failure, which can be summarized as specific measures to reduce the burden and improve the heart function of two cardiac decompensation.
(1) reduce the burden of heart: should pay attention to the following aspects:
1) to limit physical activity. Increased rest time, a day at least guarantee that sleep 10 to 12 hours. As far as possible from the left lying in order to increase the volume and cardiac output Rhodobryum roseum maintain stability.
2) to maintain the spirit of feeling and avoid emotional.
3) into the high protein, low fat, multi-vitamin diet. Limit sodium intake, daily 3 to 5 g of salt to prevent edema. Reasonable nutrition, weight control the rate of increase, so that not more than 0.5 kg per week, the entire pregnancy does not exceed 10 kg.
4) Elimination of damage heart function of a variety of factors, such as anemia, hypoproteinemia, especially vitamin B1 deficiency, infections, pregnancy-induced hypertension.
5) For blood transfusion, many times a small amount (150 ~ 200 ml); For rehydration limit at 500 ~ 1 000ml / d, Disu <10 to 15 drops / min.
(2) improve cardiac decompensation features: include the following:
1) Cardiovascular Surgery: serious illness, heart function Ⅲ ~ Ⅳ, surgery is not complicated, the main requirement anesthesia, in pregnancy can be three to four months out. Separation of emergency mitral valve (pure mitral stenosis cause acute pulmonary edema) in the pre-implementation. Patent ductus arteriosus patients during heart failure, or infection of patent ductus arteriosus, a surgical indications.
2) digitalis: the pregnant women without heart disease signs and symptoms of heart failure, digitalis in general without treatment because of digitalis non-functional at this time. Moreover, application of digitalis can not guarantee that pregnancy does not occur production congestive heart failure, in case of a reaction caused by drugs and difficulties at that time. Furthermore, the rapid digitalis and can be within a few minutes of play, such as the close observation of changes of the disease, it is not difficult to control in a timely and early heart failure. Therefore, usually only in the event of heart failure symptoms or threatened early heart failure, cardiac function Ⅲ grade 28 to 32 weeks of pregnancy (ie pregnancy hemodynamic load peak before) Application digitalis. Because pregnant women on the tolerance of poor digitalis, easy poisoning, it is chosen for rapid preparation, such as acetyl hair to spend glycosides (West to Portland) or poisonous glycoside K Mao spent drugs (drug hair Rotary Hanako glycosides K). Selection of therapy rapid excretion of digoxin, typically used to 4 to 6 weeks postpartum blood circulation have resumed normal.
In addition, heart function grade Ⅰ, Ⅱ-class pregnant women should increase the number of antenatal checks, and 20 weeks at least every two weeks ago from heart medicine, obstetric physicians inspections, a week later, if necessary, follow-up family. Except obstetric cases, the main function of cardiac decompensation and various symptoms. Regular ECG, echocardiography, and to facilitate a comprehensive estimate of the disease, found abnormal, heart failure threatened immediately hospitalized. Pre-production period of two weeks before admission to production, can be sufficient rest, but also facilitate the inspection observation. Fanxin functional class Ⅲ or heart failure should be hospitalized, and hospitalization for childbirth.
Childbirth and postpartum treatment
1. Mode of delivery options: heart disease pregnant women delivery depends primarily on the cardiac function and obstetric cases.
(1) cesarean section: cesarean section can be the end of maternity leave in a relatively short time, thus avoiding lengthy uterine contractions caused by the hemodynamic changes, such as reducing fatigue and pain caused by heart load. In addition, the continuous epidural anesthesia during surgery, pregnant women blood pressure, mean arterial pressure and heart rate changes than by vaginal delivery for small. However, the increase in surgical infection and bleeding opportunity surgery itself is a burden. Therefore, when the reasons for the existence of obstetric (such as the wrong position to abnormal fetal larger), cesarean section may be appropriate to relax indications, but only in heart function Ⅲ ~ Ⅳ, activities of rheumatic fever, pulmonary hypertension or pulmonary congestion, aortic narrow circumstances, selective cesarean section. Preoperative, intraoperative and postoperative cardiac care, anti-infection after surgery and so is the guarantee an indispensable and important safety measures.
(2) vaginal delivery: cardiac function Ⅰ and Ⅱ, unless there are obstetric complications, in principle, by vaginal delivery. Heart disease, the average middle-pregnant women and compared with normal pregnant women, there was no significant difference, but must be specifically responsible for close monitoring. After clinical use of antibiotics to prevent infection from mothers to be semi-supine, and to the oxygen. If strong contractions, pain is just unbearable, can be set for piperazine (dolantin) 50 ~ 100 mg intramuscular injection; can use continuous epidural anesthesia, can alleviate pain, and it helps the second stage of treatment. Closely observed heart rate and respiratory frequency, in the first stage, the hourly measurement once in the second stage of a measured every 10 minutes. Contractions intermittent period, such as heart rate> 100 beats / min or bilateral lung wet running at the end of a small sound and mild shortness of breath, is a precursor to severe heart failure, digitalis should be carried out immediately, intravenous injection to acetylcholine Mao Mao spent glycoside toxicity or spend glycosides K. Palace opened, and so I question the whole, appropriate fetal head high, that is, surgery to shorten the second midwifery birth process. CHD who have left to right shunt, should avoid breath action. Fetus is delivered before the shoulder immediately after the intramuscular injection of 10 mg of morphine, 10 u oxytocin. Placenta is delivered, sand bags abdominal pressure (1 kg weight). Close observation of blood pressure, pulse rate and the changes in uterine shrink. Records of vaginal bleeding.
2. Puerperium processing elements: As a result of increased care during pregnancy and labor, with more than a smooth clearance. However, if relaxed postpartum care, it is highly likely failed. According to statistics 75 per cent of maternal deaths occurred in puerperal heart disease early.
(1) continue to use antibiotics to prevent infection, to prevent subacute bacterial endocarditis occurred.
(2) had the maternal heart failure, cardiac should continue taking drugs.
(3) attention to the temperature, pulse, respiration and blood pressure, uterine bleeding and shrink complex situation.
(4) post-partum bed rest 24 to 72 hours, severe maternal heart disease should take to reduce the semi-supine Rhodobryum roseum blood and oxygen. In the absence of heart failure performance, encourage activities to get up early. Have heart failure, while bed rest should be more activities during the lower extremities to prevent thrombotic phlebitis.
(5) the cardiac function of maternal Ⅲ level and above, and after not lactating. Breastfeeding increase metabolism and amount of fluid needs, will increase the illness.
(6) post-natal hospital for observation for at least two weeks, pending improvement in cardiac function could be discharged before. Still fully discharged from the rest, restriction of activities. Strict contraception.
Diagnosis and Treatment of Heart Failure
Heart disease is based on the occurrence of congestive heart failure. From pregnancy, childbirth and postpartum hemodynamic changes of the heart impact, 32 ~ 34 weeks of pregnancy, childbirth and the postpartum period in the first three days, and patients with heart disease during the most dangerous and prone to failure. Left ventricular blood volume in excess load, faster than the right heart in heart failure; right heart in the hydrostatic load, faster than in left ventricular heart failure.
First seen at the left heart failure mitral valve disease, aortic valve disease, and because of patent ductus arteriosus or ventricular septal defect caused by the left to right shunt heart. Clinical manifestations is congestive lung and pulmonary capillary blood pressure caused by increased: difficulty breathing, sit breath, cough, hemoptysis, lung 1,10 tones, pulmonary valve area and the second heart sound hyperthyroidism FVC and venous pressure decreased to normal. Acute left ventricular failure for the performance of paroxysmal dyspnea and acute pulmonary edema.
Right heart failure usually secondary to left ventricular failure. First seen at the right heart failure pulmonary hypertension, such as pulmonary stenosis. The main clinical manifestations of the cycle of origin in venous hypertension and congestive vein: superficial venous filling, subcutaneous edema, hepatomegaly and tenderness, cyanosis, ascites, pleural effusion, pericardial effusion, as well as kidney, gastrointestinal and nervous system barriers.
1. Early diagnosis: heart decompensated heart failure functional classification that is the sub: cardiac function grade Ⅱ = mild heart failure; cardiac function grade Ⅲ = moderate heart failure; cardiac function Ⅳ class = severe heart failure.
The early symptoms of congestive heart failure: no other reasons could explain the burnout, minor activities after flu symptoms, dyspnea, and shortness of breath in sleep and awakening (or) to be boosted his head, liver pain and lower extremity edema. Early signs are: rest, heart rate> 120 beats / min, respiration> 24 beats / min, the jugular vein pulsatility increased lung wet running at the end of the sound, alternating between veins, diastolic Benma law, volume reduction and weight gain. ECG terminals V1P wave vector (PTF-V1) positive (-0.03 mm s or deeper). Continuous chest radiography (standing) shows两肺Ueno in the pulmonary vein texture thickening.
2. Treatment principles: non-pregnant women with heart failure and pregnancy were similar treatment of heart failure.
(1) strong heart: rapid myocardial digitalis preparations to improve the situation. Mao preferred to spend acetyl glycosides, with increases of 0.4 mg 25% glucose solution 20 ml, slow intravenous injection, when necessary 2 to 4 hours after the addition of 0.2 to 0.4 mg, 1.2 mg to the total available. Mao can also be used to spend glycoside toxicity K, 0.25mg a 25% increase of 20 ml of glucose, slow intravenous injection, when necessary 2 to 4 hours after injection of 0.125 to 0.25 mg, appropriate digitalis volume was 0.5 mg. Change clothes after work rapid excretion of digoxin. Pregnant women on the heart drug digitalis-like tolerance of poor, the need to closely monitor whether toxic symptoms.
(2) diuresis: commonly used furosemide 40 ~ 60 mg intravenous injection, and a diuretic to reduce blood volume and reduce cycle of pulmonary edema. Can be reused, but should pay attention to the electrolyte balance.
(3) Vasodilators: heart failure, there are peripheral contraction increased, to the heart after load increased drug application Vasodilators can play "Bloodletting" role. Selection of isosorbide dinitrate 5 ~ 10 mg, mercapto Jiabing Des Voeux leucine 12.5 mg or prazosin 1 mg three times daily.
(4) sedation: small doses of morphine (5 mg) diluted intravenous injection, not only sedation, analgesia, and the prevention of excessive exciting respiratory center and peripheral expansion, reducing the heart before and after loading, and can be anti-arrhythmia, commonly used in the acute left heart failure, pulmonary edema rescue.
(5) The reduction of blood volume Rhodobryum roseum: tourniquet pressure and legs, rotating every five minutes release a limb. Semi-supine and feet can play down the same role.
(6) antiarrhythmic: arrhythmia can be caused by heart failure, may induce or aggravate heart failure, serious should be promptly corrected. Rapid atrial ectopic rhythm with cardioversion shocks safe and effective option quinidine, procainamide, such as amide. Rapid ventricular ectopic rhythm more lidocaine hydrochloride, the United States and West law (slow rhythm), phenytoin, which is suitable for digitalis poisoning. High or complete atrioventricular block installed on the principle of temporary pacemaker, intravenous infusion can Isoproterenol.
[Clinical]
1. Heart failure: heart disease if the original heart function has been damaged or barely compensated, pregnancy and cardiac decompensation further incomplete. RHD in pregnant women, cardiac dysfunction performance: ① lung disposable blood: a predilection for mitral valve disease, in patients with dyspnea, fatigue even after, at the bottom of a small-两肺wet rales. X-ray examination showed interstitial edema. ② acute pulmonary edema: a predilection for severe mitral stenosis, high blood volume due to pulmonary hypertension. Dyspnea in patients with a sudden, not supine, cough, sputum or 1,10 bubble-like blood,两肺scattered Wheezing sound or wet rales. ③ right heart failure: common in the older, more notable expansion of the heart, atrial fibrillation, which usually diminish labor, or had heart failure in the history of the Treasury. Pregnant women earlier heart disease, patent ductus arteriosus, atrial septal defect, ventricular septal defect with pulmonary hypertension, etc., often leads to right heart failure and pulmonary valve stenosis of tetralogy of Fallot, because right ventricular pressure overload, and more for the performance of right heart failure due to aortic stenosis can be left ventricular pressure overload and form for left heart failure.
2. Infective endocarditis: Regardless of rheumatic heart disease or congenital heart disease may be due to concurrent bacteremia and infective endocarditis. If not promptly control can trigger heart failure and death.
3. Cyanosis and hypoxia: a cyanotic congenital heart disease, which is usually hypoxia and cyanosis, low gestational peripheral resistance, increasing cyanosis. Non-cyanotic type, left to right shunt CHD pregnant women, if hemorrhagic blood pressure dropped and other factors, could cause temporary reverse triage, right-to-left shunt, causing cyanosis and hypoxia.
4. Embolization: during pregnancy, blood in a hypercoagulable state, and heart disease associated with the increased venous pressure and venous blood Yuzhi, easy with embolism. Likely to come from the pelvic thrombosis, pulmonary embolism caused to increased pressure on the pulmonary circulation, thereby stimulating pulmonary edema, or left to right shunt reversal for the right-to-left shunt. If the traffic around the heart cavity congenital heart disease, thrombosis may be caused by defects peripheral arterial embolization.
[Summary]
Pregnancy heart disease can be divided into two broad categories. The first category is pre-existing heart disease, rheumatic and congenital heart disease in the majority, hypertensive heart disease, mitral valve prolapse and hypertrophic heart disease rare. The second type of heart disease induced by pregnancy, such as preeclampsia heart disease, perinatal heart.
[Diagnosis]
If pre-pregnancy with organic heart disease that is known, of course, there is no diagnosis, but some patients may not seek medical treatment without symptoms. Pregnancy caused by a series of changes in the function of the cardiovascular system, and can lead to palpitation, dyspnea and edema, and other symptoms, but also may be associated with increased heart mild heart murmur and signs, such as X-ray, electrocardiogram changes, thereby increasing cardiac diagnosis difficult. However, if the abnormality found the following should be taken into account the existence of organic heart disease.
1. Ⅲ level and above, the rough systolic murmur.
2. Diastolic murmur.
3. Serious arrhythmia, such as atrial fibrillation or flutter, such as atrioventricular block.
4.X line X-ray film showed a marked widening of cardiac image, especially individual atrial or ventricular expanded significantly.
5. Echocardiography showed heart valve, atrial and ventricular lesions.
[Treatment]
Heart monitor pregnant women
1. Termination of pregnancy indications: Can the original heart of women tolerance pregnancy, the original decision to a number of factors, such as the types of heart disease, diseases of the heart condition and whether complications. Pregnant women in the assessment of heart disease tolerance pregnancy capacity, not only need to consider carefully thought pregnancy may increase the burden on the heart and life-threatening, but also avoid excessive concern, which will rise to the loss of reproductive opportunities. Where any of the following, generally not suitable for pregnancy, early termination: ① heavier heart attack, heart function Ⅲ level and above, or had history of heart failure; ② rheumatic heart disease with pulmonary hypertension, chronic atrial fibrillation and a high degree atrioventricular resistance hysteresis, or the near future with bacterial endocarditis; ③ first obviously cyanotic congenital heart disease or pulmonary hypertension; ④ merger other more serious diseases such as nephritis, severe hypertension, tuberculosis. But if pregnancy has been more than three months, does not generally consider terminating the pregnancy, because of the sick heart, the termination of pregnancy at risk of not less than continue their pregnancy. Such as congestive heart failure has occurred, the timely termination of pregnancy is still suitable.
2. Continue to pregnancy care: heart failure is fatal heart attack pregnant women, but because heart plasma load capacity and the increase in consumption has been declaration to increase the physiological changes and decompensated heart failure caused dysfunction and the key elements. Therefore, the strengthening of pregnancy care aimed at preventing heart failure, which can be summarized as specific measures to reduce the burden and improve the heart function of two cardiac decompensation.
(1) reduce the burden of heart: should pay attention to the following aspects:
1) to limit physical activity. Increased rest time, a day at least guarantee that sleep 10 to 12 hours. As far as possible from the left lying in order to increase the volume and cardiac output Rhodobryum roseum maintain stability.
2) to maintain the spirit of feeling and avoid emotional.
3) into the high protein, low fat, multi-vitamin diet. Limit sodium intake, daily 3 to 5 g of salt to prevent edema. Reasonable nutrition, weight control the rate of increase, so that not more than 0.5 kg per week, the entire pregnancy does not exceed 10 kg.
4) Elimination of damage heart function of a variety of factors, such as anemia, hypoproteinemia, especially vitamin B1 deficiency, infections, pregnancy-induced hypertension.
5) For blood transfusion, many times a small amount (150 ~ 200 ml); For rehydration limit at 500 ~ 1 000ml / d, Disu <10 to 15 drops / min.
(2) improve cardiac decompensation features: include the following:
1) Cardiovascular Surgery: serious illness, heart function Ⅲ ~ Ⅳ, surgery is not complicated, the main requirement anesthesia, in pregnancy can be three to four months out. Separation of emergency mitral valve (pure mitral stenosis cause acute pulmonary edema) in the pre-implementation. Patent ductus arteriosus patients during heart failure, or infection of patent ductus arteriosus, a surgical indications.
2) digitalis: the pregnant women without heart disease signs and symptoms of heart failure, digitalis in general without treatment because of digitalis non-functional at this time. Moreover, application of digitalis can not guarantee that pregnancy does not occur production congestive heart failure, in case of a reaction caused by drugs and difficulties at that time. Furthermore, the rapid digitalis and can be within a few minutes of play, such as the close observation of changes of the disease, it is not difficult to control in a timely and early heart failure. Therefore, usually only in the event of heart failure symptoms or threatened early heart failure, cardiac function Ⅲ grade 28 to 32 weeks of pregnancy (ie pregnancy hemodynamic load peak before) Application digitalis. Because pregnant women on the tolerance of poor digitalis, easy poisoning, it is chosen for rapid preparation, such as acetyl hair to spend glycosides (West to Portland) or poisonous glycoside K Mao spent drugs (drug hair Rotary Hanako glycosides K). Selection of therapy rapid excretion of digoxin, typically used to 4 to 6 weeks postpartum blood circulation have resumed normal.
In addition, heart function grade Ⅰ, Ⅱ-class pregnant women should increase the number of antenatal checks, and 20 weeks at least every two weeks ago from heart medicine, obstetric physicians inspections, a week later, if necessary, follow-up family. Except obstetric cases, the main function of cardiac decompensation and various symptoms. Regular ECG, echocardiography, and to facilitate a comprehensive estimate of the disease, found abnormal, heart failure threatened immediately hospitalized. Pre-production period of two weeks before admission to production, can be sufficient rest, but also facilitate the inspection observation. Fanxin functional class Ⅲ or heart failure should be hospitalized, and hospitalization for childbirth.
Childbirth and postpartum treatment
1. Mode of delivery options: heart disease pregnant women delivery depends primarily on the cardiac function and obstetric cases.
(1) cesarean section: cesarean section can be the end of maternity leave in a relatively short time, thus avoiding lengthy uterine contractions caused by the hemodynamic changes, such as reducing fatigue and pain caused by heart load. In addition, the continuous epidural anesthesia during surgery, pregnant women blood pressure, mean arterial pressure and heart rate changes than by vaginal delivery for small. However, the increase in surgical infection and bleeding opportunity surgery itself is a burden. Therefore, when the reasons for the existence of obstetric (such as the wrong position to abnormal fetal larger), cesarean section may be appropriate to relax indications, but only in heart function Ⅲ ~ Ⅳ, activities of rheumatic fever, pulmonary hypertension or pulmonary congestion, aortic narrow circumstances, selective cesarean section. Preoperative, intraoperative and postoperative cardiac care, anti-infection after surgery and so is the guarantee an indispensable and important safety measures.
(2) vaginal delivery: cardiac function Ⅰ and Ⅱ, unless there are obstetric complications, in principle, by vaginal delivery. Heart disease, the average middle-pregnant women and compared with normal pregnant women, there was no significant difference, but must be specifically responsible for close monitoring. After clinical use of antibiotics to prevent infection from mothers to be semi-supine, and to the oxygen. If strong contractions, pain is just unbearable, can be set for piperazine (dolantin) 50 ~ 100 mg intramuscular injection; can use continuous epidural anesthesia, can alleviate pain, and it helps the second stage of treatment. Closely observed heart rate and respiratory frequency, in the first stage, the hourly measurement once in the second stage of a measured every 10 minutes. Contractions intermittent period, such as heart rate> 100 beats / min or bilateral lung wet running at the end of a small sound and mild shortness of breath, is a precursor to severe heart failure, digitalis should be carried out immediately, intravenous injection to acetylcholine Mao Mao spent glycoside toxicity or spend glycosides K. Palace opened, and so I question the whole, appropriate fetal head high, that is, surgery to shorten the second midwifery birth process. CHD who have left to right shunt, should avoid breath action. Fetus is delivered before the shoulder immediately after the intramuscular injection of 10 mg of morphine, 10 u oxytocin. Placenta is delivered, sand bags abdominal pressure (1 kg weight). Close observation of blood pressure, pulse rate and the changes in uterine shrink. Records of vaginal bleeding.
2. Puerperium processing elements: As a result of increased care during pregnancy and labor, with more than a smooth clearance. However, if relaxed postpartum care, it is highly likely failed. According to statistics 75 per cent of maternal deaths occurred in puerperal heart disease early.
(1) continue to use antibiotics to prevent infection, to prevent subacute bacterial endocarditis occurred.
(2) had the maternal heart failure, cardiac should continue taking drugs.
(3) attention to the temperature, pulse, respiration and blood pressure, uterine bleeding and shrink complex situation.
(4) post-partum bed rest 24 to 72 hours, severe maternal heart disease should take to reduce the semi-supine Rhodobryum roseum blood and oxygen. In the absence of heart failure performance, encourage activities to get up early. Have heart failure, while bed rest should be more activities during the lower extremities to prevent thrombotic phlebitis.
(5) the cardiac function of maternal Ⅲ level and above, and after not lactating. Breastfeeding increase metabolism and amount of fluid needs, will increase the illness.
(6) post-natal hospital for observation for at least two weeks, pending improvement in cardiac function could be discharged before. Still fully discharged from the rest, restriction of activities. Strict contraception.
Diagnosis and Treatment of Heart Failure
Heart disease is based on the occurrence of congestive heart failure. From pregnancy, childbirth and postpartum hemodynamic changes of the heart impact, 32 ~ 34 weeks of pregnancy, childbirth and the postpartum period in the first three days, and patients with heart disease during the most dangerous and prone to failure. Left ventricular blood volume in excess load, faster than the right heart in heart failure; right heart in the hydrostatic load, faster than in left ventricular heart failure.
First seen at the left heart failure mitral valve disease, aortic valve disease, and because of patent ductus arteriosus or ventricular septal defect caused by the left to right shunt heart. Clinical manifestations is congestive lung and pulmonary capillary blood pressure caused by increased: difficulty breathing, sit breath, cough, hemoptysis, lung 1,10 tones, pulmonary valve area and the second heart sound hyperthyroidism FVC and venous pressure decreased to normal. Acute left ventricular failure for the performance of paroxysmal dyspnea and acute pulmonary edema.
Right heart failure usually secondary to left ventricular failure. First seen at the right heart failure pulmonary hypertension, such as pulmonary stenosis. The main clinical manifestations of the cycle of origin in venous hypertension and congestive vein: superficial venous filling, subcutaneous edema, hepatomegaly and tenderness, cyanosis, ascites, pleural effusion, pericardial effusion, as well as kidney, gastrointestinal and nervous system barriers.
1. Early diagnosis: heart decompensated heart failure functional classification that is the sub: cardiac function grade Ⅱ = mild heart failure; cardiac function grade Ⅲ = moderate heart failure; cardiac function Ⅳ class = severe heart failure.
The early symptoms of congestive heart failure: no other reasons could explain the burnout, minor activities after flu symptoms, dyspnea, and shortness of breath in sleep and awakening (or) to be boosted his head, liver pain and lower extremity edema. Early signs are: rest, heart rate> 120 beats / min, respiration> 24 beats / min, the jugular vein pulsatility increased lung wet running at the end of the sound, alternating between veins, diastolic Benma law, volume reduction and weight gain. ECG terminals V1P wave vector (PTF-V1) positive (-0.03 mm s or deeper). Continuous chest radiography (standing) shows两肺Ueno in the pulmonary vein texture thickening.
2. Treatment principles: non-pregnant women with heart failure and pregnancy were similar treatment of heart failure.
(1) strong heart: rapid myocardial digitalis preparations to improve the situation. Mao preferred to spend acetyl glycosides, with increases of 0.4 mg 25% glucose solution 20 ml, slow intravenous injection, when necessary 2 to 4 hours after the addition of 0.2 to 0.4 mg, 1.2 mg to the total available. Mao can also be used to spend glycoside toxicity K, 0.25mg a 25% increase of 20 ml of glucose, slow intravenous injection, when necessary 2 to 4 hours after injection of 0.125 to 0.25 mg, appropriate digitalis volume was 0.5 mg. Change clothes after work rapid excretion of digoxin. Pregnant women on the heart drug digitalis-like tolerance of poor, the need to closely monitor whether toxic symptoms.
(2) diuresis: commonly used furosemide 40 ~ 60 mg intravenous injection, and a diuretic to reduce blood volume and reduce cycle of pulmonary edema. Can be reused, but should pay attention to the electrolyte balance.
(3) Vasodilators: heart failure, there are peripheral contraction increased, to the heart after load increased drug application Vasodilators can play "Bloodletting" role. Selection of isosorbide dinitrate 5 ~ 10 mg, mercapto Jiabing Des Voeux leucine 12.5 mg or prazosin 1 mg three times daily.
(4) sedation: small doses of morphine (5 mg) diluted intravenous injection, not only sedation, analgesia, and the prevention of excessive exciting respiratory center and peripheral expansion, reducing the heart before and after loading, and can be anti-arrhythmia, commonly used in the acute left heart failure, pulmonary edema rescue.
(5) The reduction of blood volume Rhodobryum roseum: tourniquet pressure and legs, rotating every five minutes release a limb. Semi-supine and feet can play down the same role.
(6) antiarrhythmic: arrhythmia can be caused by heart failure, may induce or aggravate heart failure, serious should be promptly corrected. Rapid atrial ectopic rhythm with cardioversion shocks safe and effective option quinidine, procainamide, such as amide. Rapid ventricular ectopic rhythm more lidocaine hydrochloride, the United States and West law (slow rhythm), phenytoin, which is suitable for digitalis poisoning. High or complete atrioventricular block installed on the principle of temporary pacemaker, intravenous infusion can Isoproterenol.
[Clinical]
1. Heart failure: heart disease if the original heart function has been damaged or barely compensated, pregnancy and cardiac decompensation further incomplete. RHD in pregnant women, cardiac dysfunction performance: ① lung disposable blood: a predilection for mitral valve disease, in patients with dyspnea, fatigue even after, at the bottom of a small-两肺wet rales. X-ray examination showed interstitial edema. ② acute pulmonary edema: a predilection for severe mitral stenosis, high blood volume due to pulmonary hypertension. Dyspnea in patients with a sudden, not supine, cough, sputum or 1,10 bubble-like blood,两肺scattered Wheezing sound or wet rales. ③ right heart failure: common in the older, more notable expansion of the heart, atrial fibrillation, which usually diminish labor, or had heart failure in the history of the Treasury. Pregnant women earlier heart disease, patent ductus arteriosus, atrial septal defect, ventricular septal defect with pulmonary hypertension, etc., often leads to right heart failure and pulmonary valve stenosis of tetralogy of Fallot, because right ventricular pressure overload, and more for the performance of right heart failure due to aortic stenosis can be left ventricular pressure overload and form for left heart failure.
2. Infective endocarditis: Regardless of rheumatic heart disease or congenital heart disease may be due to concurrent bacteremia and infective endocarditis. If not promptly control can trigger heart failure and death.
3. Cyanosis and hypoxia: a cyanotic congenital heart disease, which is usually hypoxia and cyanosis, low gestational peripheral resistance, increasing cyanosis. Non-cyanotic type, left to right shunt CHD pregnant women, if hemorrhagic blood pressure dropped and other factors, could cause temporary reverse triage, right-to-left shunt, causing cyanosis and hypoxia.
4. Embolization: during pregnancy, blood in a hypercoagulable state, and heart disease associated with the increased venous pressure and venous blood Yuzhi, easy with embolism. Likely to come from the pelvic thrombosis, pulmonary embolism caused to increased pressure on the pulmonary circulation, thereby stimulating pulmonary edema, or left to right shunt reversal for the right-to-left shunt. If the traffic around the heart cavity congenital heart disease, thrombosis may be caused by defects peripheral arterial embolization.
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