First, gestational diabetes.
1. Pregnancy complicated with diabetes includes two situations, namely, pre-pregnancy diabetes and diabetes that occurs or is first discovered after pregnancy. The latter is also called gestational diabetes mellitus (GDP), accounting for more than 80% of the total number of gestational diabetes mellitus and 1%-5% of the total number of pregnant women. Most of them can recover after delivery. However, 33.3% of the patients still turned to diabetes in 5- 10 years after delivery, and should be followed up regularly.
Diagnostic criteria (only one of the following needs to be met): ① The results of oral glucose tolerance test are abnormal twice; ② Fasting blood glucose ≥5.8mmol/L twice and ≥11.1mmol/L at any one time, and fasting blood glucose ≥5.8mmol/L was measured again. The latter accounts for the majority.
2. The influence of diabetes on mother and baby
1. Influence on pregnant women Diabetic pregnant women are prone to pregnancy-induced hypertension, polyhydramnios, premature rupture of membranes and premature delivery. In addition, there are many functional defects in white blood cells of diabetic patients, so the obstetric infection rate increases. Due to the insufficient utilization of sugar, abnormal labor process, postpartum hemorrhage and increased surgical yield often occur.
2. Impact on Fetus and Newborns Because the high concentration of glucose in the blood of diabetic pregnant women can easily pass through the placenta, but insulin can't, it can stimulate fetal islets to produce a large amount of insulin for a long time, increase the synthesis of fetal protein and fat, and inhibit fat degradation, so the incidence of fetal macrosomia is high. In addition, the incidence of deformed children is also high, which can cause stillbirth, stillbirth, neonatal hypoglycemia and respiratory distress syndrome.
3, the principle of processing
1. Children with diabetes are not suitable for pregnancy if they have serious complications, such as renal insufficiency and serious cardiovascular diseases. If you are pregnant, you should terminate the pregnancy as soon as possible.
2. For those who continue pregnancy, obstetricians and doctors actively cooperate to control blood sugar at 6. 1 1 ~ 7.77 mmol/L through diet or drug treatment. Pregnancy is usually terminated within 37 ~ 38 weeks. If prenatal examination finds obstetric complications such as placental dysfunction, we should weigh the advantages and disadvantages and make corresponding treatment. Vaginal delivery is generally appropriate. If there are macrosomia, placental dysfunction or other obstetric indications, cesarean section should be appropriate. Prevention of puerperal infection and postpartum hemorrhage during puerperium.
4, neonatal care:
Take care of premature babies regardless of their weight. Take umbilical cord blood to test blood sugar at birth, and take 25% glucose solution regularly after 30 minutes to prevent hypoglycemia, and pay attention to prevent hypocalcemia, hyperbilirubinemia and neonatal respiratory distress syndrome. Most newborns can return to normal blood sugar within 6 hours after birth.
5, health education:
1. It is very important to detect blood sugar and urine sugar regularly. The standard of good blood sugar control: fasting blood sugar
2, avoid eating too much food at a time, advocate a small number of meals. Eat more green vegetables, beans, coarse grains and low-sugar fruits and stick to a low-salt diet. Try not to eat bananas, grapes, persimmons, pears, oranges, apples and other fruits with high sugar content. But eat more fruits with low sugar content such as melon, tomato and cucumber.
3, porridge can make blood sugar rise rapidly, blood sugar maintenance time is short, leading to blood sugar instability, which is not good for pregnant women and fetuses. So, try to eat less porridge.
During pregnancy, insulin is the only drug that can be used to control blood sugar. It is necessary to correctly grasp the dosage and time of medication.
5. Pay attention to personal hygiene and often cut your nails. Pay attention to keep warm to prevent colds.
6, the law of life, pay attention to rest, to ensure adequate sleep. However, you should also exercise properly. You can choose aerobic exercise or walking. Maintaining emotional stability and listening to light music can not only ease the mood, but also give prenatal education to the baby.
Second, hypertensive disorder complicating pregnancy
1, overview
Hypertensive disorder complicating pregnancy is a unique disease during pregnancy. The incidence rate in China is 9.4%. The name of this disease emphasizes the causal relationship between pregnancy and symptoms such as hypertension and proteinuria in women of childbearing age. Most cases have transient hypertension, proteinuria and other symptoms during pregnancy, which disappear immediately after delivery. The disease seriously affects the health of mother and infant, and is the main cause of morbidity and mortality of pregnant women and perinatal infants.
2. Etiology
The etiology is unknown, but it may be related to the following factors:
1. Young or elderly primiparas
2. Complicated with polyhydramnios, diabetes, severe anemia and hydatidiform mole.
3. The family has a history of hypertension
4. Cold season or temperature difference change
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3. Basic pathological changes
The basic pathological change of hypertensive disorder complicating pregnancy is systemic arterial spasm. Due to systemic arteriolar spasm, peripheral vascular resistance increases and blood pressure rises. Glomerular vasospasm, lumen stenosis, hypoxia of vascular wall tissue, increased permeability, protein overflow and proteinuria. The glomerular filtration rate decreases, and the sodium clearance decreases and stays outside the cell, resulting in edema. The prognosis of this disease is closely related to hypertension and proteinuria, but not to edema.
4. Auxiliary inspection
Fundus examination: the degree of retinal arteriole spasm reflects the degree of systemic arteriole spasm and can reflect the severity of the disease. Usually, retinal arteriole spasm, retinal edema, flocculent exudation or bleeding can be seen in fundus examination, and retinal detachment can occur in severe cases. Patients may have blurred vision or blindness. Urine test: urine specific gravity, urine routine and urine specific gravity should be measured; = 1.020 indicates urine concentration, and the urine protein content is 300 mg/24h when the urine protein is+; When the urine protein (++), the urine protein content is 5g/24h. Patients with severe pregnancy-induced hypertension should have a urine protein check every two days.
5, the principle of treatment
1. Increase the frequency of prenatal examination and closely observe the changes of the disease.
2. Pay attention to proper rest. When resting, lie on your side as much as possible and touch the oppression of the right uterus on the inferior vena cava, thus improving the blood supply of the placenta.
3. Pay attention to ensure that the intake of protein, vitamins, calcium and iron in the diet is sufficient, and there is no need to limit salt except systemic edema.
4. Drug therapy, the principle of treatment is spasmolysis, sedation, hypotension, diuresis, volume expansion and timely termination of pregnancy.
5. Supplement: drug therapy
Spasmodic drugs: Magnesium sulfate is the first choice for the prevention and treatment of eclampsia.
Sedative drugs: commonly used sedatives include diazepam and hibernating spirit.
Antihypertensive drugs: Ding Liqi, hydralazine, Ravello, nifedipine, nimodipine, methyldopa, sodium nitroprusside, etc.
Diuretics: Generally speaking, it is not recommended, and only suitable for those with systemic edema, acute heart failure, pulmonary edema, hypervolemia and potential pulmonary edema. Commonly used diuretics include furosemide and mannitol.
Volume expansion: Generally speaking, it is not recommended to use volume expansion agent, which is only used for systemic hypoproteinemia and anemia, and human albumin, plasma and whole blood can be selected.
Use of magnesium sulfate:
The toxic dose of magnesium sulfate is very close to the therapeutic dose, so it is easy to cause poisoning. When magnesium ion is poisoned, the knee joint reflex disappears and the muscle strength of the whole body decreases, whew.
Inhalation is inhibited, and in severe cases, cardiac arrest occurs.
Therefore, when using magnesium sulfate treatment, it should be determined that there is knee reflex; Breathe no less than 16 times per minute; 24-hour urine volume should be not less than 600ml, not less than 25ml per hour. At the same time, 10% calcium gluconate 10ml must be prepared as an antidote.