Monitorizarea si tratamentul de urgenta in sarcina...
Transcript of Monitorizarea si tratamentul de urgenta in sarcina...
![Page 1: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/1.jpg)
Monitorizarea si tratamentul
de urgenta in sarcina
patologica
![Page 2: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/2.jpg)
Sarcina patologica Clasificare
Sarcina patologica explicata de patologie asociata
Sarcina patologica explicata de nidatia anormala a oului:
- sarcina ectopica
- placenta praevia
Sarcina patologica explicata de durata anormala:
- avortul
- nasterea prematura
- sarcina supramaturata
Sarcina patologica explicata de anomalii ale elementelor ovulare:
- sarcina molara
- patologia lichidului amniotic
- patologia cordinului ombilical
- patologia membranelor
- patologia fetala
- sarcina gemelara
- incompatibilitatile sanguine materno-fetale
- suferinta fetala
- moartea produsului de conceptie
Disgravidiile
![Page 3: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/3.jpg)
Patologia comuna si sarcina
Diagnosticul si tratamentul bolilor comune in sarcina poate
fi complicat de mai multi factori:
1. Sarcina modifica unii parametrii fiziologici. Aceste
modificari pot mima semne si simptome de boala complicind
diagnosticul.
2. Sarcina poate agrava boala.
3. Sarcina poate fi afectata de boala
4. Sarcina poate fi afectata de tratament.
![Page 4: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/4.jpg)
Patologia comuna si sarcina
Infectiile generale acute
Prognostic matern: rezervat; sarcina afecteaza evolutia bolilor
infectioase; infectiile localizate au tendinta la generalizare iar
Cele generalizate imbraca forme clinice grave.
Perioada critica: trim. III, nasterea, lehuzia. Boala se agraveaza
daca sarcina se intrerupe in faza acuta.
Prognostic ovular: bacteriile si virusurile trec placenta –
afecteaza produsul de conceptie – avort, nastere prematura,
nastere de copii distrofici, malformati, morti, bolnavi.
Medicamentele necesare pt tratamentul bolilor pot afecta si ele
produsul de conceptie.
![Page 5: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/5.jpg)
Patologia comuna si sarcina
Conduita
Profilactica: evitare contaminare, vaccinari
Curativa:
- tratamentul bolii folosind medicamente fara efecte negative
asupra fatului;
- avort terapeutic: in cazurile cu risc mare matern sau fetal
Malformatii:
rubeola 80%
rujeola 8%
Parotidita epidemica 12%
Gripa 5%
Varicela 6%
![Page 6: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/6.jpg)
Patologia comuna si sarcina
Complexul TORCH
Infectie congenitala cu
Toxoplasma
Rubeola
Citomegalovirus
Herpes simplex
Determina malformatii fetale
![Page 7: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/7.jpg)
Toxoplasmoza
T. gondii: protozoar care determina fetopatia toxoplasmica
Tetrada simptomatica: hidrocefalie evolutiva, calcificari cerebrale
periventriculare, corioretinita, crize epileptiforme
Manifestari extranervoase: icter, tulb. cardio-pulmonare si digestive
Forme asimptomatice: puseuri tardive cu afectri oculare
Frecventa in Romania: 23 %
Infectie materna: 80-90% forme usoare/asimptmatice;
Clinic: febra, stare generala influentata, adenopatie cervicala
Rar: corioretinita, encefalopatie, pneumonie
Transmitere congenitala: se face doar in infectie acuta aparuta in
sarcina; transplacentar functie de parazitemia materna
Infectia cronica a endometrului cu forme pseudochistice
Diagnostic:
Serodiagnostic: test Sabin Feldman > 1/1000
Imunofluorescenta indirecta
Profilaxie: igiena
![Page 8: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/8.jpg)
Tratament:
In timpul sarcinii: Rovamicina (Spiramicina) 50-100 mg/kg; cure
succesive 2g/zi 20-30 zile cu pauze de 5 zile
Pediatru: evaluarea nou nascutului
![Page 9: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/9.jpg)
HIV / SIDA
Retrovirusul poate fi transmis prin contact sexual, expunere la sange
infectat sau produse de sange si perinatal de la mama la nou nascut
Femei cu risc:
- utilizatoarele de droguri iv
- din tarile cu transmitere heterosexuala frecventa
- prostituate
- cele cu parteneri ce folosesc droguri, bisexuali, hemofilici, HIV
Clasificarea infectiei HIV
Grup I: infectie initiala dovedita prin seroconversie. Majoritatea sunt
asimptomatici.
Grup II: infectie cronica asimptomatica cu anomalii la examenele de
laborator: anemie, leucopenie, scaderea limfocitelor T helper < 400/m3,
raport T4/T8 < 1 la 75% cazuri
Grup III: adenopatie persistenta generalizata
Grup IV: alte boli: diaree, mielopatii, infectii asociate
![Page 10: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/10.jpg)
Infectia cu HIV este confirmata prin enzime imuno assay (EIA) si apoi
prin Western blot.
Acuratete EIA 99% daca e efectuata I conditii optime
Rezultate fals negative – primele 1-2 sapt dupa infectie
Transmitere perinatala – SIDA la copii
Prezenta la copil – risc la mama si la sarcina urmatoare chiar daca
mama nu are simptome
Sdr dismorfic: microcefalie, bose frontale proeminente, nas aplatizat,
fante palpebrale largi
Femeile din grupele cu risc necesita testare repetata
La gravidele sero+ se indica avrotul terapeutic
Nastere prin cezariana
Izolare ca la hepatita
![Page 11: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/11.jpg)
Infectii cronice
Sifilisul
Prognostic matern: leziuni precoce sau persistente, aspect clinic florid
Prognostic ovular: pasajul transplacentar – leziuni ale tuturor
elementelor oului
La fat: moarte in utero, leziuni luetice precoce; sifilis congenital tardiv
Tratament: unitati speciale, copil monitorizat clinic + serologic 4 ani
![Page 12: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/12.jpg)
Cardiopatiile
Clasificare NYHA
Cl I: asimptomatica
Cl II: dispnee, tahicardie la activ obisnuite
Cl III: dispnee la efort minim
Cl IV: dispnee de repaus
Prognostic matern: rezervat
Complicatii: insuficienta cardiaca, edem pulmonar acut, cardiopatie
ischemica, tulb de ritm, embolie pulmonara, endocardita
Prognostic fetal: relativ bun; hipoxia materna cronica – hipotrofie
fetala
Conduita: trat chirurgical al cardiopatiei
Avort terapeutic = cl III-IV
Dispensarizare cardiologica /ginecologica/ati
![Page 13: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/13.jpg)
Tbc pulmonar
Agravat de sarcina
Complicatii: hemoptizie, peumotorax spontan, leziuni difuze
Prognostic ovular: in general bun; BK nu trece placenta
Conduita:
Evitare sarcina pina la vindecare
Avort terapeutic in formele recente sau evolutive
Nastere naturala, forceps; cezariana in formele grave
Izolare imediata a nou nascutului; alaptare contraindicata
Apendicita
Diagnostic dificil
Prognostic matern: grav – acutizare, peritonita
Prognostic ovular: in formele acute – contractii uterine –
avort, nastere prematura
Conduita
Chirurgicala in forma acuta indiferent de varsta sarcinii
Medical in forma cronica
![Page 14: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/14.jpg)
Infectia urinara
Evolutie: asimptomatica, acuta, cronica
Clinic: febra, dureri lombare, polakiurie, usturimi mictionale
Prognostic ovular: contractii – intreruperea sarcinii
Tratament: antibiotice
Anemiile
20-75% cazuri
Hematii < 3,5 mil/mm3; Hb < 11 g%; Ht < 34%
Carentiale: Fe, acid folic, proteine
Posthemoragice
Diabetul
Prognostic matern: complicatii diabet-cetoacidoza, coma, hipoglicemia
Complicatiile sarcinii: HTA, infectii urinare, vaginite
Complicatiile nasterii: exces de volum fetal, moartea fatului
Conduita: evitarea sarcinii
Corectarea in colaborare cu diabetologul, monitorizare
![Page 15: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/15.jpg)
Hemoragiile in timpul sarcinii
1. Prima jumatate a sarcinii
- Avort
- Sarcina ectopica
- Sarcina molara
- Endometrita deciduala
2. A doua jumatate a sarcinii
- Placenta praevia
- Apoplexia utero-placentara
![Page 16: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/16.jpg)
Sarcina ectopica
Frecventa 2-3%
Clasificare: ovariana (1%), peritoneala (1%), tubara (98%),
cervicala
Etiologie
Cauze ovulare: dezvoltare prea rapida, lichid periovular aderent,
vascos
Cauze materne:
- ingustarea lumenului tubar-malformatii, infectii, endometrioza
- bride peritubare
- tumori uterine sau anexiale
Complicatii
Precoce: disolutia oului, avort tubo-abdominal, ruptura trompei,
avort cervical
Tardive: ruptura chistului fetal, infectia chistului fetal, moartea
fatului
![Page 17: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/17.jpg)
Diagnostic: inundatia peritoneala
Conduita:
- Conservatoare
- Radicala
- Medicala
![Page 18: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/18.jpg)
![Page 19: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/19.jpg)
![Page 20: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/20.jpg)
![Page 21: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/21.jpg)
![Page 22: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/22.jpg)
Placenta praevia
Insertia placentei se face la nivelul segmentului inferior
Clasificare: laterala, marginala, centrala
Etiologie: sarcina multipla, endometrita
Diagnostic: clinic, ecografia
Prognostic matern si fetal: rezervate
Conduita:
Profilactic
Curativ
![Page 23: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/23.jpg)
![Page 24: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/24.jpg)
Avortul
Eliminarea produsului de conceptie inainte de 28 sapt sau < 1000 g
Clasificare:
- Spontan
- Terapeutic
- Delictual
Avort spontan:
Frecventa: 5-15%
Etiologie:
- factori externi (effort fizic, trepidatii, dezechilibre
alimentare, noxe);
- factori de mediu intern: aberatii cromozomiale, infectii cronice,
intoxicatii cronice, afectiuni materne (generala, genitale), stari
patologice ale elementelor oului
![Page 25: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/25.jpg)
Clasificare: diagnostic
- iminenta de avort
- Avortul in evolutie
- Avortul incomplet
Tratament
![Page 26: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/26.jpg)
![Page 27: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/27.jpg)
![Page 28: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/28.jpg)
Mola hidatiforma
Transformarea chistica a vilozitatilor coriale si proliferarea
trofoblastului
Frecventa: 1/2000
Clasificare:
- neinvaziva (totala, partiala, incapsulata, difuza, atrofica,
recidivanta)
- invaziva
- corio-carcimon
Etiopatogenie: vasculara, imunologica, genetica
Diagnostic: clinic, paraclinic (eco, betaHCG crescut)
Conduita: evacuare (chiuretaj, operatie)
Monitorizare HCG
Metotrexat
![Page 29: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/29.jpg)
![Page 30: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/30.jpg)
Nasterea prematura
- Nasterea ce se produce la o varsta gestationala intre 28-37 sapt,
fatul avand greutatea < 2500 g
- frecventa: 6-10%
Clasificare:
iminenta de nastere prematura
nastere prematura declansata
Etiopatogenie: sarcina multipla, RPM, placenta praevia,
polihidramnios, malformatii congenitale uterine, insuficienta
cervico-istmica, disgravidia tardiva, factori generali, necunoscuta
(50%)
Diagnostic: INP, NPD
Prognostic:
Matern
Fetal: imediat si tardiv
![Page 31: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/31.jpg)
Nasterea prematura
Conduita
Profilactica:
Riscul NP (nivel socio-economic, antec personale, mod de viata,
complicatii in timpul sarcinii)
Curativa: INP
NPD
asistenta nou nascut
![Page 32: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/32.jpg)
Sarcina supramaturata
Sarcina ce evolueaza > 42 sapt (294 zile)
Cauze materne: factori hormonali si umorali, anomalii uterine,
infectii genitale, carente alimentare, disgravidie tardiva,
primiparitate, predispozitie individuala
Cauze ovulare: malformatii fetale (anencefalia), sexul masculin fetal,
continut redus in lichidul amniotic de substante cu actiune
ocitocica, insuficienta placentara
Diagnostic: clinic si paraclinic
Prognostic: matern si fetal
Conduita: declansare sau cezariana
![Page 33: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/33.jpg)
Patologia lichidului amniotic
Polihidramniosul
Oligoamniosul
Patologia cordonului ombilical
Insertie velamentoasa
Circulara sau procidenta de cordon
Patologia membranelor
Ruptura prematura a membranelor
Chorio-amniotita
![Page 34: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/34.jpg)
Sarcina gemelara
Clasificare: monozigotica; dizigotica
Etiologie: ereditatea, varsta inaintata, multiparitate,
inductori de ovulatie
Diagnostic
Conduita
Prognostic
![Page 35: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/35.jpg)
Disgravidii – manifestari patologice induse de sarcina ce dispar cel
mai adesea dupa evacuarea oului din uter.
Clasificare
A. precoce: ptialismul, varsaturile disgravidice
B. tardive: in a doua jum a sarcinii, consecinta unui spasm vascular
localizat sau generalizat in circulatia materna
HTA indusa de sarcina
TA > 140/90 mm Hg
1. HIS necomplicata
2. HIS complicata
Preeclampsia
Eclampsia
![Page 36: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/36.jpg)
Decolarea prematura de placenta normal inserata (DPPNI)
- Dezlipirea partiala sau totala a placentei de pe suprafata de
insertie inaintea expulziei fatului urmata de formarea unui
hematom intre placenta si corpul uterin
- 1% din disgravidiile majore
Clasificare:
- De cauza traumatica
- De cauza generala
Diagnostic: functie de marimea zonei decolate:
- Forma usoara: hematom 40-60 ml
- Forma medie: hematom 3-400 ml
- Forma grava: hematom > 1000 ml
Uter: hipertonie, BCF absente, tulb de coagulare
![Page 37: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/37.jpg)
Prim ajutor: decubit lateral stang, antispastic
Internare de mare urgenta
Conduita:
Profilactica: evitarea traumelor abdominale, regim alimentar
echilibrat, consultatie prenatala corecta
![Page 38: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/38.jpg)
![Page 39: Monitorizarea si tratamentul de urgenta in sarcina patologicaiasi-medecine.weebly.com/uploads/5/4/8/2/5482113/5.sarcina_pato... · Prognostic matern: complicatii diabet-cetoacidoza,](https://reader030.fdocument.pub/reader030/viewer/2022020113/5a78f4467f8b9a77088da863/html5/thumbnails/39.jpg)