妇产科学 6 妊娠合并肝炎、糖尿病学习资料.ppt

PregnancycomplicatesViralHepatitis

妊娠合并病毒性肝炎上海交大医学院附属仁济医院妇产科张羽博士，副主任医师rjzhangyu@163.com2016年2月26日

FunctionofliverproductsandsecretsproteinsPlayrolesinmetabolismofcarbohydrates,lipidsSynthesizescoagulationfactorsI,II,V,VII,VIII,IX,XandXI,aswellasproteinC,proteinSandducesandexcretesbile(whichhelptheabsorptionofvitaminKfromthediet)breakdownofinsulinandotherhormonesEtc.2

Viralhepatitis:HepatitisAHepatitisBHepatitisCHepatitisDHepatitisEOtherviruses3

Symptomsofviralhepatitis4

Symptomsofviralhepatitis5

HepatitisA6

HepatitisB:7

HepatitisB:8

HepatitisB:9

HepatitisC:10

HepatitisD:11

HepatitisE:12

Agiftaninterestingwebsite:/wiki/File:Viral_hepatitis.webm13

DifferentialdiagnosisICP(intrahepaticcholestasisofpregnancy)HELLPsyndrome(hemolysis,elevatedliverenzymes,lowplatelets)Acutefattyliverofpregnancy14

TreatmentAnti-viraltherapyMedicationforprotectionofliverLaboranddeliveryBreast-feeding15

ProphylaxisHBVimmunoprophylaxisVaccinesforpeopleathigh-riskofcontactingHBVinfectionMother：BepassivelyimmunizedwithhepatitisBIg(HBIg)inthethirdtrimester(50%↓)Infant:receivecombinedtherapywithHBIgandvaccination16

KeywordsVerticaltransmissionDifferentialdiagnosisofviralhepatitis17

GestationalDiabetesMellitus（GDM)

妊娠期糖尿病上海交大医学院附属仁济医院妇产科张羽博士，副主任医师rjzhangyu@163.com2016年2月26日

ClassificationGestationaldiabetes:diagnosedduringpregnancy（90%）Overtdiabetesduringpregnancy(10%)tohavediabetesbeforepregnancy19

DMisametabolicdisordercharacterizedbyhyperglycemiaThecauseofDMismultifactorial(genetic,immune,environmental,viral,)GDM:1%~5%inChina3%-10%inUSA20

Effectsofpregnancyonglucosemetabolism/diabetes1.Diataryhabitschanges2.Insulinloadincrease3.Anti-insulinhormonesfromplacentaprolactinestrogenprogesteroneinsulinase21

MaternaleffectsGlucosuriaHyperglycemiaDiabetesketoacidosisInfectionPIH/PreeclampsiaNeph