1. Pregnancy With Internal Medical Diseases Yinglin Liu( 刘颖琳 ) MD&PhD, Department of Gyn & Obs The 2 nd Affiliated Hospital of Sun Yat-sen University

4. Part One Cardiovascular Diseases

5. Pregnancy complicated with Heart Disease Incidence of pregnancies:1-4% Death rate: 0.6%-2.7% 2nd leading cause of maternal mortality: 8.3%

13. Congenital heart disease With large L-to-R shunt: pulmonary artery hypertension ， right-left shunt ， cyanosis Blood shunt only from L to R / No blood shunt Blood shunt from R to L Noncyanotic Cyanotic Atrial septal defect, ventricular septal defect, Patent ductus arteriosus Pulmonary stenosis, Coartation of aorta, Marfan’s syndrom Tetralogy of Fallot Eisenmenger’s syndrom . Withstand hemodynamic change of pregnancy and labor with small shunt Pregnancy is contraindicated

33. Part Two Acute Viral Hepatitis

44. Viral hepatitis ICP Acute fatty liver of pregnancy HELLP syndrome Hyperemesis gravidarum Drug induced hepatitis onset All time Late Late Late Early All time Inducement - - - PIH - Drug use symptoms Gastrointestinal, jaundice pruritus-jaundice epigastric pain, vomiting, acute liver failure epigastric pain, jaundice, bleeding Prolonged vomiting Jaundice and prutitus after drug intake Lab findings Hepatitis virus positive Cholic acid  serum bilirubin  urine bilirubin(-) Hemolysis, coagulopathy, BPC  Water, salt and ph imbalance acidophil  Hepatic disfunction Light-severe light Acute and severe severe light light pathology Hepatocyte damage Intrahepatic cholestasis Fat filled in cytoplasm ischemia light light fetus Malformation,demise distress death death light light prognosis prolonged Recover after delivery poor Recover after delivery recover Recover

49. Part III Diabetes Mellitus

55. Minor adverse health effects for offspring in GDM Birth Wt (g) 3303 ±64 3649 ±51 3849 ±72 <0.01 Macrosomia(%) 8 36 47 <0.01 C-S 5 10 14 <0.01 Hypoglycemia 2 28 52 <0.01 Hypocalcemia 0 4 7 <0.01 Hyperbilirubinemia 15 23 21 <0.01 Polycythemia 0 7 11 <0.01 Cord C-Pep 1.18±0.1 2.07±0.12 2.98±0.22 <0.01 Cord Glu 100±3.6 103±2.9 114±5.5 <0.01 Normal GDM DM P

57. White grouping class description A Abnormal OGTT treat only by diet therapy B Onset at age 20years or older and duration of less than 10 years C Onset at age 10-19 years or duration of 10-19years D Onset before 10 years of age, duration over 20 years, exudative retinopathy E Calcification of pelvic cavity vasculopathy by X-ray F Nephropathy R proliferative retinopathy RF proliferative retinopathy and Nephropathy G Many pregnancy failure H coronary heart disease T Prior renal transplantation

59. Standard of blood glucose controled Time blood glucose fasting blood glucose 3.3~5.6mmol/L two hours after meal 4.4~6.7mmol/L at night Before three meals 4.4~6.7mmol/L 3.3~5.8mmol/L

63. Low-dosage constant insulin infusion for the intrapartum period blood-glucose (mg/100ml ） Insulin dosage （ U/h ） fluids （ 125ml/h ） <100 0 5%dextrose/lactated Ringer’s solution 100~140 1.0 5%dextrose/lactated Ringer’s solution 141~180 1.5 Normal saline 181~220 2.0 Normal saline >220 2.5 Normal saline dilution is 25U regular insulin in 250ml normal saline, administerd intravenously

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