Transtornos Hipertensivos Del Embarazo 2012

8/17/2019 Transtornos Hipertensivos Del Embarazo 2012

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T RANST ORNOS HIP ERT ENSIV OS DEL EMBARAZ O

MARIANA C ORNU SANC HEZ P ROF ESOR: DR. ESAUL HERNANDEZ ARV IZ U

F AC ULT AD DE MEDIC INA LEON


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OBJETIVOS1. Describir l clsi!cci"# $ el %i"s'ic(

%i)ere#cil*. Es'blecer l !si(+'(l(&, %e l

+reecl-+si. Re/isr s0s l'erci(#es e#%(cri#s $

-e'b"lics. P0#'0li2r l +r(!l3is $ el 'r'-ie#'(4. C(-+re#%er el )0'0r( %i"s'ic( $

'er+50'ic( %el s,#%r(-e %e HELLP $ %e l+reecl-+si ecl-+si


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IMPORTANCIA6 Trs'(r#(s 7i+er'e#si/(s

c(-+lic# 4 168 %e '(%(s l(se-br2(s

6Mie-br( %e l 'ri% le'l 90#'(c(# 7e-(rr&i e i#)ecci"# e#-(r'li%% $ -(rbili%%-'er#s

618 %e ls -0er'es -'er#s se%ebe 'rs'(r#(s 7i+er'e#si/(se# +,ses %esrr(ll%(s


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CLASIFICACI;N

6Hi+er'e#si"# &es'ci(#l

6S,#%r(-e %e +reecl-+si $ecl-+si

6S,#%r(-e %e +reecl-+sis0+er+0es'( 7i+er'e#si"#cr"#ic

6Hi+er'e#si"# cr"#ic


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DIA


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6 TA -$(r %e 16=>6 --H& +(r +ri-er /e2 %es+05s *6 SD<

6 Si# +r('ei#0ri 6 P0e%e 7ber ('r(s si(s ( s,#'(-s %e +reecl-+si

6 Csi l -i'% %esrr(llr? +reecl-+si

6 D3 !#l %es+05s %el +r'(

6Si #( 7$ e/i%e#ci %e +reecl-+si $ l TA se #(r-li27ci ls 1* se-#s +(s' +r'( hipertensión transitoria

HIPERTENSI;N


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PREECLAMPSIA

CRITERIOSMINIMOS

•

TA @16=>6%es+05s %e *6 SD<• Pr('ei#0ri @ 66

-&=* 7 ( @ 1 c(#'ir rec'i/

MAYOR CERTEZA

• TA @16=116• Pr('ei#0ri @ *.6=* 7 ( @ *

c(# 'ir rec'i/• Cre'i#i# s5ric >1.* -&• Pl0e's


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ECLAMPSIA

6A+rici"# %e crisis c(#/0lsi/s e# -09er c(#+reecl-+si 0e #( +0e%e# 'rib0irse ('rs c0ss

6


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PREECLAMPSIASUPERPUESTA A

HIPERTENSI;N CR;NICA6Pr('ei#0ri %e i#ici( recie#'e @ 66 -&=* 7

e# -09eres 7i+er'e#ss +er( si# +r('ei#0ri#'es %e *6 SD<

6A0-e#'( sGb%i'( %e +r('ei#0ri TA (Pl0e's


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HIPERTENSI;N CR;NICA

6 TA @16=>6 #'es %ele-br2( ( %3 #'es %e *6SD<

(6 Hi+er'e#si"# %i(s'ic%

%es+05s %e *6 s%& $ 0e+ersis'e 1* se-#s %es+05s

%el +r'(


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PREECLAMPSIA

6 Trs'(r#( -0l'isis'5-ic(. E'i(l(&, G#%esc(#(ci%.

6Se crc'eri2 +(r +rese#'r 0# res+0es'/sc0lr #(r-l l +lce#'ci"# $ 0e ses(ci l(s si&0ie#'es c-bi(s:

• I#cre-e#'( e# l res+0es' /sc0lr sis'5-ic• A0-e#'( e# l &re&ci"# +l0e'ri• Ac'i/ci"# %el sis'e- %e c(&0lci"#• Dis)0#ci"# cel0lr e#%('elil


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FACTORES DE RIES


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FACTORES DE RIES


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Plce#'ci"#%e!cie#'e'e-+r#

* ETAPAS:


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ETIOLO


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INVASI;N TROFOBLKSTICAANORMAL

6 Ar'eri(ls s0)re# re-(%el%( l ser i#/%i%s +(r'r()(bls'(s e#%(/sc0lres

6 E# l +reecl-+si 7$ i#/si"# 'r()(bl?s'ici#c(-+le'. I#/si"# %e /s(s %eci%0les $ #(-i(-e'riles


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INVASI;N TROFOBLKSTICAANORMAL

6 Ar'eri(ls -i(-e'riles #(+ier%e# rec0bri-ie#'(e#%('elil %i?-e'r( re%0ci%(

6 Hi+(3i ( is0e-i +lce#'risec0#%ri hipoperfusióntrofoblastica

6 Liberci"# %e %e'ri'0s+lce#'ri(s 0e i#%0ce recc.

I#-'(ri sis'5-ic

6 D( e#%('elil


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C-bi(s +reecl?-'ic(s

'e-+r#(sD( e#%('elil

I#s0%ci"# %e

c(-+(#e#'es %el +ls- +re%es %e l(s /s(s

Ac0-0lci"# %el,+i%(s $ %es+05s-cr")&(s e# c5l0ls%e -i(,#'i-

Pr(li)erci"# %ec5l0ls %e-i(,#'i-

Necr(sis %e l-e%i


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Ac'i/ci"# e#%('elil

A#'i(3i%#'es


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FACTORES INMUNITARIOS

6Desre&0lci"#= +5r%i% %e '(ler#cii#-0#i'ri -'er# #',&e#(s +lce#'ri(s$ )e'les

6C-bi(s 7is'(l"&ic(s se-e9#'es e#c(#'r%(s e# rec72( &0%( %el i#9er'(

6Preecl-+si -s 'e-+r# c(# -$(r%(sis %e #',&e#(s +'er#(s 'ris(-, 1e-br2( -(lr

6+r('ecci"# e# -09eres e3+0es's+re/i-e#'e #',&e#(s +'er#(s


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Fc'(res #0'rici(#les

6Die' l' e# )r0's $ /er%0rs TA e#+(blci"# &e#erl

6Ac. sc"rbic(


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PA

TO

<E

NI

A


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E-br2%s#(r-('e#ss

E-br2%s+reecl-'ics

PA

TO

<E

NI

A

Vs(c(#s'ric'(r +('e#'e


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PA

TO

<E

NI

A

Secreci"# %e s0s'#cis+r(c(&0l#'es

A0-e#'( %e se#sibili%% /s(+res(res

Ele/ci"# %e c5l0lse#%('eliles circ0l#'es7s' 3


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PA

TO

<E

NI

A

Res+0es' +res(r0-e#'%

M$(r rec'i/i%% #(re+i#e)ri# $A#&i('e#si# II e# -09eres c(#+reecl-+si 'e-+r#


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PA

TO

<E

NI

A

Pr(bble c(-+0es'( 0e-#'ie#e /s(%il'ci"#e# rie&( )e'(+lce#'ri(

I#7ibici"#ele/ TAM


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PATO


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PATO


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FISIOPATOLO


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APARATO

CARDIOVASCULARLs l'erci(#es se relci(##c(#:

1. I#cre-e#'( e# +(s'cr&cr%ic +(r HTA

*. Precr& cr%ic l'er%. Ac'i/ci"# e#%('elil

e3'r/sci"# 7ci es+ci(

l/e(lr c(-+lic%( c(#+resi"# (#c"'ic


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VOLUMEN SAN


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VOLUMEN SAN


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SAN


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SAN


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HEMOSTASIA DELVOLUMEN

6Me#(r c(#ce#'rci"# %e renina2 angiotensina1-3 # aldosterona 0e e# e-br2( #(r-l

6Des(3ic(r'ic(s'er(#. Mi#erl(c(r'ic(i%e-0$ 0-e#'%( e# e-br2( #(r-l #( sere%0ce #i c(# re'e#ci"# %e N #i HTA

6V(l0-e# %e l,0i%( e3'rcel0lr -0c7(-$(r 0e e# e-br2(s #(r-les

E%e-.


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HEMOSTASIA DEL

VOLUMEN6C(#ce#'rci(#es %e elec'r(li'(s #( /r,# %e)(r- i-+(r'#'e ls %e e-br2%s#(r-les.

6Des+05s %e crisis c(#/0lsi/ +H $bicrb(#'( seric(s


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RIONES6C-bi(s #'"-ic(s $ !si(+'(l"&ic(sre/ersibles6Per)0si"# $ !l'rci"# &l(-er0lr re%0ci%s: /(l0-e# +ls-?'ic(

resis'e#ci r'eri(ls)ere#'es6Cre'i#i# s5ric $ ci%( Gric( ele/%(s6N( i#)0si"# i#'e#si/ %e l,0i%(s e# cs( %e

(li&0ri -e#(s 0e es' se %eb 7e-(rr&i


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RIONES

CAMBIOS ANAT;MICOS6


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RIONES

CAMBIOS ANAT;MICOS6


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RIONES

6Hi#c72"# e#%('elil +r(bble-e#'e %ebi% 0se#ci %e )c'(r #&i(&5#ic(

6Ese#cil +r sl0% %e +(%(ci'(s.6Desc'i/ci"# %e )c'(r #&i(&5#ic( =

%is)0#ci"# +(%(ci'ri e 7i#c72"# e#%('elil6A0-e#'( %e e3creci(# %e +(%(ci'(s e#

ecl-+si


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PROTEINURIA

6Es'blece el D3 %e +reecl-+si ecl-+si6P0e%e +recer e# )se 'r%,6

Se i#/es'i& -i'0% %e e3creci"# c(-(i#%ic%(r %e &r/e%% %e +reecl-+si


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H


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H


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CEREBROLESIONES ANAT;MICAS6He-(rr&i i#'rcerebrl

-cr(sc"+ic6He-(rr&is +e'e0iles

c(r'icles $ s0bc(r'icles6He-(rr&i e# &#&li(s bsles

-0c7s /eces c(# r0+'0r /e#'r,c0l(s

6E%e- s0bc(r'icl6Ares %e rebl#%eci-ie#'( #(

7e-(rr&ics


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CEREBRO

* TEORIAS PARA EWPLICAR ALTERACIONES ENPREECLAMPSIA:1. Re&0lci"# /sc0lr e3cesi/ e# res+0es'

7i+er'e#si"# &0% es+s-( /sc0lr09( s#&0,#e( %is-i#0i%( is0e-ie%e- i#)r'(

*. Ele/ci(#es sGb%i's %e TA rebs#

c+ci%% %e 0'(rre&0lci"# re&i(#es%e /s(c(#s'ricci"# $ /s(%il'ci"#)(r2% l'erci"# 7i%r(s''ic e#c+ilres e%e- /sc0lr.


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CEREBRO

6A0'(rre&0lci"# %e 09( s#&0,#e( cerebrl'(ler TAM %e 7s' 16 --&H -0c7(-$(re 0e (bser/%s e# ecl-+si

6Al'er% e# el e-br2(6Ecl-+si (c0rre c0#%( 7i+er+er)0si"#

cerebrl e-+09 l l,0i%( c+ilr 7cies+ci( i#'ers'icil &e#er#%( el e%e-

+eri/sc0lr 0e se i%e#'i!c e# el s,#%r(-e%e +reecl-+si


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CEREBRO

MANIFESTACIONES CLNICAS6Ce)le $ esc('(-s: se cree 0e s(# %ebi%(s

7i+(+er)0si"#. 46X48 ce)le *668 c-bi(s

/is0les. Des+rece# %es+05s %e %-i#is'rr s0l)'(%e M&6C(#/0lsi(#es6Ce&0er: +(r l( &e#erl re/ersible +0e%e &e#errse e#

?res. C(r'e2 /is0l (cci+i'l -0r(sis N0cle(s

&e#ic0l%(s l'erles $ re'i# re'i#(+', %eP0r'sc7er %es+re#%i-ie#'( %e re'i#6E%e- cerebrl &e#erli2%(: c-bi(s e# es'%(

-e#'l. Des%e c(#)0si"# 7s' c(-.


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SINDROME DE HELLP

Plaquetas < 100 000/mm3TGO/AST @70/!"#! @$00/!%ilirrubina total & 1'( m)/*l


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TRATAMIENTO6Se 'r' se&G# &r/e%% e%% &es'ci(#l $

+rese#ci %e +reecl-+si6L 'er-i#ci"# %el e-br2( es l G#ic c0r

+r l +reecl-+si


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TRATAMIENTO6P+,,-!A.PSA !,,

YM#e9( -b0l'(ri( +cie#'e c(#!bleYH(s+i'li2ci"#: Hi+er'e#si"# %e i#ici(

recie#'e +ersis'e#'e crecie#'e ( %esrr(ll( %e+r('ei#0ri. Vl(rci"# sis'5-icY-(#i'(ri2ci"# c% %,sYBGs0e% i#'e#ci(#% %e )c'(res %e

se/eri%%. U-brl b9( e# #0l,+rsYVl(rr #'i7i+er'e#si/(s


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TRATAMIENTO6P+,,-!A.PSA S,,+A6YH(s+i'li2ci"# $ M(#i'(re( c(#'i#0(6YA#'i7i+er'e#si/(s i#'e#'r -#'e#er e# 146=6[

166 --H&.6YBGs0e% i#'e#ci(#% %e si(s %e ecl-+si%escr'r S3 %e HELLP e IRA

6,-!A.PSA6YA#'eri(r6YS0l)'( %e Mesi( D(sis %e cr& &. IV e#

166 -l %e s(l0ci"# IV e# 14*6 -i#. M#'e#i-ie#'(1* &r=7(r


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ANTIHIPERTENSORES

Bl(0e%(r %re#5r&ic(


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i#'err0+ci"# %el

e-br2(INDICACIONES MATERNAS6Desc(#'r(l 7i+er'e#si/(6%is-i#0ci"# +r(&resi/ %e

+l0e's +(r %eb9( %e

1666666%e'eri(r( +r(&resi/( %e l)0#ci"# 7e+?'ic ( re#l

6s(s+ec7 %e br0+'i( +lce#'e6c-bi(s /is0les ( ce)le

se/er +ersis'e#'e6#?0se/"-i'( ( %(l(re+i&?s'ric( +ersis'e#'e

6ecl-+si

INDICACIONES FETALES6Res'ricci"# &r/e %el

creci-ie#'(6

Oli&(7i%r-#i(s &r/e ILA


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Pre/e#ci"#

nter2ención *iettica

6%ie' b9 e# sl6c(-+le-e#'ci"# c(# clci(

6 c(-+le-e#'ci"# c(# cei'e %e+esc%(

ANTITROMB;TICOS6AAS 46146-& /, (rl +(r %,

re%0cci"# %e 168 ries&( rel'i/(

%e +reecl-+si6AAS 7e+ri# b0e#(s res0l'%(s

0# #( se 7ce# rec(-e#%ci(#es


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BIBLIO

Transtornos Hipertensivos Del Embarazo 2012

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