pregnancy induced hypertension

妊娠高血圧症候群 PIH

WordNet

1. reason or establish by induction
2. cause to arise; "induce a crisis" (同)bring_on
3. produce electric current by electrostatic or magnetic processes (同)induct
4. cause to do; cause to act in a specified manner; "The ads induced me to buy a VCR"; "My children finally got me to buy a computer"; "My wife made me buy a new sofa" (同)stimulate, cause, have, get, make
5. cause to occur rapidly; "the infection precipitated a high fever and allergic reactions" (同)stimulate, rush, hasten
6. the state of being pregnant; the period from conception to birth when a woman carries a developing fetus in her uterus (同)gestation, maternity
7. brought about or caused; not spontaneous; "a case of steroid-induced weakness"

PrepTutorEJDIC

1. 〈人〉‘に'『勧めて』(…)『させる』 / …‘を'『引き起こす』,もたらす(cause) / 〈電気〉‘を'誘導する / …‘を'帰納する
2. 〈U〉〈C〉妊娠の状態(期間) / 〈U〉《文》含蓄
3. 高血圧[症] / 過度の緊張

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/01/11 21:07:41」(JST)

wiki en

[Wiki en表示]

Pregnancy-induced hypertension
Classification and external resources
Micrograph showing hypertrophic decidual vasculopathy, the histomorphologic correlate of gestational hypertension. H&E stain.
ICD-10	O13-O14
ICD-9	642
DiseasesDB	5208
MedlinePlus	000898
eMedicine	med/3250
MeSH	D046110

Gestational hypertension or pregnancy-induced hypertension (PIH) is defined as the development of new arterial hypertension in a pregnant woman after 20 weeks gestation without the presence of protein in the urine.

Conditions

There exist several hypertensive states of pregnancy:

Gestational hypertension

Gestational hypertension is usually defined as having a blood pressure higher than 140/90 without the presence of protein in the urine and diagnosed after 20 weeks of gestation.

Preeclampsia

Pre-eclampsia is gestational hypertension (blood pressure greater than 140/90) plus proteinuria (>300 mg of protein in a 24-hour urine sample). Severe preeclampsia involves a blood pressure greater than 160/110, with additional medical signs and symptoms.

Eclampsia

This is when tonic-clonic seizures appear in a pregnant woman with high blood pressure and proteinuria.

HELLP syndrome

This is a dangerous combination of three medical conditions: hemolytic anemia, elevated liver enzymes and low platelet count.

Acute fatty liver of pregnancy

This is sometimes included in the preeclamptic spectrum.

Pre-eclampsia and eclampsia are sometimes treated as components of a common syndrome.

Risk factors

• Family history of pre-eclampsia
• Pre-existing hypertension
• Renal disease
• Diabetes mellitus
• Obesity
• Placental abnormalities:

1. Hyperplacentosis: Excessive exposure to chorionic villi.

2. Placental ischemia.

• Multiple gestation (twins or triplets, etc.)
• Age 35 or greater
• Adolescent pregnancy
• New paternity
• African American race^{[citation needed]}
• Thrombophilias (anti-phospholoipid syndrome, protein C/S deficiency, factor V Leiden)

Etiopathological factors for pre-eclampsia

• Failure to trophoblast invasion (abnormal placentation)
• Vascular endothelial damage
• Inflammatory mediator (cytokines)
• Immunological intolerance between maternal and fetal tissues
• Coagulation abnormalities
• Increased oxygen free radicals
• Genetic predisposition (polygenic disorders)
• Dietary deficiency or excess

Treatment

There is no specific treatment, but is monitored closely to rapidly identify pre-eclampsia and its life-threatening complications (HELLP syndrome and eclampsia).

Drug treatment options are limited, as many antihypertensives may negatively affect the fetus. Methyldopa, hydralazine, and labetalol are most commonly used for severe pregnancy hypertension.

The fetus is at increased risk for a variety of life-threatening conditions, including pulmonary hypoplasia (immature lungs). If the dangerous complications appear after the fetus has reached a point of viability, even though still immature, then an early delivery may be warranted to save the lives of both mother and baby. An appropriate plan for labor and delivery includes selection of a hospital with provisions for advanced life support of newborn babies.

References

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 子癇前症：臨床的特徴および診断 preeclampsia clinical features and diagnosis
• 2. 子癇前症：管理および予後 preeclampsia management and prognosis
• 3. 子癇前症の予測 prediction of preeclampsia
• 4. Expectant management of preeclampsia with severe features
• 5. 子癇前症：予防 preeclampsia prevention

English Journal

• Microparticles: biomarkers and beyond.

• Burger D, Schock S, Thompson CS, Montezano AC, Hakim AM, Touyz RM.SourceKidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. dburger@uottawa.ca
• Clinical science (London, England : 1979).Clin Sci (Lond).2013 Apr;124(7):423-41. doi: 10.1042/CS20120309.
• Membrane microparticles are submicron fragments of membrane shed into extracellular space from cells under conditions of stress/injury. They may be distinguished from other classes of extracellular vesicles (i.e. exosomes) on the basis of size, content and mechanism of formation. Microparticles are
• PMID 23249271

• NADPH oxidase 2-derived superoxide downregulates endothelial KCa3.1 in preeclampsia.

• Choi S, Kim JA, Na HY, Kim JE, Park S, Han KH, Kim YJ, Suh SH.SourceDepartment of Physiology Medical School, Ewha Womans University, Seoul 158-710, Republic of Korea.
• Free radical biology & medicine.Free Radic Biol Med.2013 Apr;57:10-21. doi: 10.1016/j.freeradbiomed.2012.12.009. Epub 2012 Dec 20.
• Endothelial dysfunction is associated with K3.1 dysfunction and contributes to the development of hypertension in preeclampsia. However, evidence of endothelial K3.1 dysfunction in the vascular system from women with preeclampsia is still lacking. Therefore, we examined whether endothelial K3.1 dysf
• PMID 23261940

• MicroRNA-376c Impairs Transforming Growth Factor-β and Nodal Signaling to Promote Trophoblast Cell Proliferation and Invasion.

• Fu G, Ye G, Nadeem L, Ji L, Manchanda T, Wang Y, Zhao Y, Qiao J, Wang YL, Lye S, Yang BB, Peng C.SourceDepartment of Biology, York University, 4700 Keele St, Toronto, Ontario, Canada. cpeng@yorku.ca.
• Hypertension.Hypertension.2013 Apr;61(4):864-72. doi: 10.1161/HYPERTENSIONAHA.111.203489. Epub 2013 Feb 19.
• Preeclampsia is a major disorder of pregnancy and a leading cause of maternal and perinatal morbidity and mortality. MicroRNAs are small noncoding RNAs that regulate gene expression posttranscriptionally. In this study, we examined the expression of miR-376c and found that miR-376c levels were downr
• PMID 23424236

Japanese Journal

• 1)母体・胎児管理のポイント(I.重症妊娠高血圧症候群の重篤な合併症予防対策,日産婦医会共同企画 症例から学ぶ-ハイリスク妊娠への対応,第63回日本産科婦人科学会 第63回学術講演会生涯研修プログラム,研修コーナー)

• 竹田 省
• 日本産科婦人科學會雜誌 63(12), "N-261"-"N-265", 2011-12-01
• NAID 110008799078

• 母体疾患(<特集>胎児の発達・発育と外部環境)

• 平松 祐司
• 日本産科婦人科學會雜誌 63(10), 1977-1984, 2011-10-01
• NAID 110008750329

Related Links

• Gestational Hypertension: Pregnancy Induced Hypertension

Gestational hypertension is characterized by high blood pressure during pregnancy. It is important to treat this early to prevent further complications. ... Gestational hypertension, also referred to as pregnancy induced hypertension ...

• How to Recognize Pregnancy Induced Hypertension (PIH)

What Is Pregnancy-Induced Hypertension (PIH) Hypertensive disorders of pregnancy, previously know as Pregnancy-induced hypertension (PIH), are high blood pressure disorders of pregnancy. It has long been one of the major ...

---

★リンクテーブル★

リンク元	「妊娠高血圧症候群」「妊娠高血圧」「PIH」
拡張検索	「pregnancy-induced hypertension」
関連記事	「induce」「induced」「hypertension」

「妊娠高血圧症候群」

　　[★]

英

pregnancy induced hypertension, PIH

関

[[]]

• 妊娠中毒症の名称、定義、分類は2005年4月で改正された

定義 NGY.392

• 妊娠20週以降、分娩後12週までに1),2)のいずれかであって、かつこれらの症候が偶発合併症によらないもの

• 1) 高血圧が見られる
• 2) 高血圧にタンパク尿を伴う

疫学

• 初産婦、高齢妊婦(35歳以上)で発生しやすい
• 妊娠前BMI24以上で2-3倍の発症率
• 双胎妊娠では30-40%発症リスクが高まる。

分類

病型

• 妊娠高血圧 gestational hypertension：妊娠20週以降の高血圧
• 妊娠高血圧腎症 preeclampsia：妊娠20週以降の高血圧＋蛋白尿
• 加重型妊娠高血圧腎症 preeclampsia superimposed on chronic hyupertension and/or renal disease

• 以前からの蛋白尿　＋　妊娠20週以降の高血圧
• 以前からの高血圧　＋　妊娠20週以降の蛋白尿
• 以前からの高血圧・蛋白尿　→　妊娠20週以降に増悪

• 子癇 eclampsia：妊娠20週以降のけいれん

重症度

	軽症	重症
収縮期血圧	140-160mmHg	>160mmHg
拡張期血圧	90-110mmHg	>110mmHg
蛋白尿	300-2000mg/day	>2000mg/day

妊娠高血圧腎症と加重型妊娠高血圧腎症の比較

QB.P-239

	妊娠高血圧腎症	加重型妊娠高血圧腎症
経産回数	初産婦に多い	経産婦に多い
後遺症	なし(分娩後早期に症状消失)	高血圧
再発	難	易。妊娠回数に比例

病態生理

• 組織レベルでは、血圧上昇・血管収縮(血管の攣縮)、凝固の促進(血管内凝固の促進)、腎の虚血、糸球体障害、血管透過性の亢進が起きており、鼓音結果として高血圧、蛋白尿、浮腫をきたすと考えられている。(NGY.394)

病理

• 胎盤：胎盤血管の壊死、血栓形成。
• 腎臓：メサンギウム細胞、上皮細胞、内皮細胞を中心とした増殖性糸球体の変化を生じる。蛋白尿の原因は限外濾過の破綻である。(NGY.394)

症候

• 高血圧、蛋白尿、浮腫

治療

NGY.396 G10M.99

極端な塩分・水分制限は循環動態を悪化させる

• 生活療法：安静
• 食事療法：塩分制限(6-8g)、低カロリー
• 薬物療法：降圧薬(ヒドララジン、αメチルドパ)

• 浮腫：利尿薬の使用は子宮胎盤循環を悪化させうるので肺水腫合併以外には禁忌。
• 子癇：予防的に硫酸マグネシウム投与
• 血栓：予防的にアンチトロンビン、ヘパリンなど

「妊娠高血圧」

　　[★]

英

gestational hypertension, pregnancy-induced hypertension, pregnancy induced hypertension PIH

関

妊娠中毒症、妊娠高血圧症候群

同

GH

「PIH」

　　[★]

• 妊娠高血圧症候群 pregnancy induced hypertension
• プロラクチン抑制ホルモン prolactin-inhibiting hormone

「pregnancy-induced hypertension」

　　[★]

妊娠高血圧、妊娠性高血圧、妊娠性高血圧症

関

gestational hypertension

「induce」

　　[★]

• v.

• 誘発する、誘導する、誘起する、導入する、引き起こす

関

cause、challenge、derivation、elicit、elicitation、evocation、evoke、guidance、induction、inductive、introduce、introduction、precipitate、provocation、provoke、spark

　 　 　 　 　 　

「induced」

　　[★]

• v.

• (induceの過去分詞)誘導される、引き起こされる

hypercalcaemia induced pancreatitis 高カルシウム血症による膵炎

　

「hypertension」

　　[★] 高血圧, 高血圧症, HT