2. kehamilan dan hipertensi

7/28/2019 2. Kehamilan Dan Hipertensi

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Hypertensive Disorder in Pregnancy

dr. Valleria, SpOG


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Hypertensive Disorder inPregnancy

1. Gestational hypertension ( Hipertensidalam Kehamilan )

2. Preeclampsia3. Eclampsia4. Superimposed Preeclampsia

5. Chronic Hypertension


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Hypertensive Disorder inPregnancy

One of the deadly triad (hemorrhage,

infection)3,7 % of all pregnancy


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1. Ges tas ion al hy p er ten s ion

BP > 140/90 mmHg for first time duringpregnancyNo proteinuriaBP return to normal < 12 weeks postpartum

May have other signs for preeclampsia(epigastric discomfort, thrombpcytopenia)


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2. Preec lam p s ia

Preeclampsia: Mild-Severe

Mild :- BP > 140/90 mmHg after 20 weeks

gestation- Proteinuria > 300 mg/24 hours or > 1+

dipstick


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Preeclampsia

Severe- BP > 160/110 mm Hg- Proteinuria 2 g/24 hours or > 2+ dipstick- Serum Creatinin > 1,2 mg/dL- Platelets < 100.000/mm3- Increase LDH- Elevated AST/ALT- Persistent headache or other cerebral or

visual disturbance- Persistent epigastric pain


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3. Eclam p s ia

Seizures that cannot be attributed to other

causes in women with preeclampsiaComa

Eklampsia imminens severe headache or visual disturbances


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4. Sup er im p o sed preeclam p sia

New onset proteinuria > 300mg/24 hours

in hypertensive women but no proteinuriabefore 20 weeks gestasionSign and symptoms severe preeclampsia


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5. Chro n ic Hyp er ten s ion

BP > 140 mmHg before pregnancy or diagnosed before 20 weeks gestation


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Risk Facto r Preec lam p sia

NulliparousMultiple pregnancy

History of chronic hypertensionMaternal age over 35 yearsObesity


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Patop hy is io log y Preec lam ps ia

Maternal vascular deseaseFaulty placentationExcessive trophoblast

Reduced uteroplacental perfusion

Endothelial activation


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Endothelial activation

Vasospasme Capillary leak Activation of coagulation

-Hypertension-Seizure-Oliguria- Abruption-Liver ischemia

EdemaProteinuriaHemoconcentration

Thrombocytopenia


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Gen eral Man ag em en t o f Sev ere Preec lam p s ia

1. Delivery is the cure for preeclampsia> 35 weeks gestation : induction of labor < 35 weeks gestation, no complication:

expectant ( the hope that few more weeks inutero will reduce the risk of neonatal mortalityand morbidity )

- Anti hypertension-

Lung maturation : dexametason 12 mg/day, 2 days- Observation : Blood pressure, symptom impandingeclampsia, lab., fetal surveillance any disturbance

termination


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Gen eral Managem ent o f Sev ere Preeclampsia

2. Anti hypertensive Drug- -blocking agent : labetolol- Calcium channel blocker : nifedipine- ACE inhibitor

(Angiotensin-converting-enzyme): should beavoided : oligohidramnios, IUGR, limb

contractur, Persistent PDA, pulmonaryhypoplasia, etc

- Methyldopa : delayed onset (long-acting)


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Gen eral Managem ent o f Sev ere Preeclampsia

3. Preventive and control convulsion- MgSO 4 : control convulsion without central

nervous system depression- i.v : 4-6 g loading dose diluted in 100 ml of

iv fluid 15-20 min, maintenance 1-2 g/ hour in 100 ml

- i.m : 4 g loading dose, 5 g i.m in bothbuttock / 4 hour


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General Man ag em ent o f Sev er Preeclampsia

Before giving MgSO 4 :1. The patellar refleks is present

2. Respiration are not depressed ( RR>16/min)3. Urin output > 100ml/4 hour MgSo 4 is discontinued 24 h after delivery

MgSO 4 toxicity : respiratory depression,paralysis, and arrest Antidotum MgSO 4 : calcium gluconate


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Severe Preeclampsia

> 35 weeks gestasion : termination of pregnancy< 35 weeks gestasion :- Find any complications if any termination

of pregancy and treat complication- No diuretik-

Limitation activity- MgSO4- Antihypertensive agents- Close observation for mother and baby


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Man agem en t o f Mild Preeclampsia

> 37 weeks gestation : termination of pregnancy< 37 weeks gestation :

- No medication if blood pressure not more than 140/90

mmHg- No diuretik- Limitation activity- ANC 2x/weeks : Blood Pressure, proteinuria, refleks,

fetal surveillance- Close monitoring for complications


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Management of chronichypertension/gestational

hypertension

Find any complications during antenatal care

Antihypertensive drugs control bloodpressureIf no complications wait until aterm with close

monitoringIf there is any complications consider pregnancy termination


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Compl ica t ion

1. Eclampsia

- Generalized tonic-clonic seizures- Coma without convulsion- Antepartum, intrapartum, postpartum

- Cerebral edema- ICU


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Compl ica t ion

2. HELLP Syndrome

- Hemolysis : fragmented erythrocyte, bilirubun >

1,2 ml/dL- Elevated Lever enzymes : SGOT > 72 IU/L, LDH

> 600IU/L- Low Platelet count : < 100.000/mm3- DIC- Tx : dexamethason 2 x 10 mg, then 2 x 5 mg


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Compl ica t ion

3. Pulmonary edema

- Tachypneu/dyspnea- Respiratory distress- Severe hypoxemia- Diffuse rales in both lung- ICU, ventilator - Furosemid


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Compl ica t ion

4. Acute Renal Failure5. Hepatic rupture

6. Abruptio placentae7. Cerebral hemorrhage8. Visual disturbances


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Prevent ion

Low dose aspirin ?Calcium?

Anti oxidant?

2. kehamilan dan hipertensi

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