Download - 4. Hipertensi Pada Kehamilan
![Page 1: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/1.jpg)
Hypertensive Disorder Hypertensive Disorder in Pregnancyin Pregnancy
Oleh. Hj. Siti Isye NasripahOleh. Hj. Siti Isye Nasripah
![Page 2: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/2.jpg)
Penyakit Hipertensi pada Penyakit Hipertensi pada KehamilanKehamilan
1.1. Gestational hypertension ( Hipertensi Gestational hypertension ( Hipertensi dalam Kehamilan )dalam Kehamilan )
2.2. PreeclampsiaPreeclampsia3.3. EclampsiaEclampsia4.4. Superimposed Preeclampsia Superimposed Preeclampsia 5.5. Chronic HypertensionChronic Hypertension
![Page 3: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/3.jpg)
EpidemiologiEpidemiologi
One of the deadly triad (hemorrhage, One of the deadly triad (hemorrhage, infection)infection)
3,7 % of all pregnancy 3,7 % of all pregnancy
![Page 4: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/4.jpg)
Gestasional hypertensionGestasional hypertensionBP BP >> 140/90 mmHg, setelah usia 140/90 mmHg, setelah usia
kehamilan > 20 minggu tanpa adanya kehamilan > 20 minggu tanpa adanya riwayat HTriwayat HT
No proteinuriaNo proteinuriaBP return to normal < 12 weeks (3 bulan) BP return to normal < 12 weeks (3 bulan)
post partumpost partum
![Page 5: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/5.jpg)
PreeclampsiaPreeclampsiaMild :Mild :- BP BP >> 140/90 mmHg after 20 weeks 140/90 mmHg after 20 weeks
gestationgestation- Proteinuria Proteinuria >> 300 mg/24 hours or 300 mg/24 hours or >> 1+ 1+
dipstickdipstick- Edema generalisataEdema generalisata
![Page 6: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/6.jpg)
PreeclampsiaPreeclampsiaSevereSevere
- BP BP >> 160/110 mm Hg 160/110 mm Hg- Proteinuria 2 g/24 hours or Proteinuria 2 g/24 hours or >> 2+ dipstick 2+ dipstick- Serum Creatinin > 1,2 mg/dLSerum Creatinin > 1,2 mg/dL- Platelets < 100.000/mm3Platelets < 100.000/mm3- Increase LDHIncrease LDH- Elevated AST/ALTElevated AST/ALT- Persistent headache or other cerebral or Persistent headache or other cerebral or
visual disturbancevisual disturbance- Persistent epigastric painPersistent epigastric pain
![Page 7: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/7.jpg)
EclampsiaEclampsia
Seizures that cannot be attributed to other Seizures that cannot be attributed to other causes in women with preeclampsiacauses in women with preeclampsia
ComaComa
![Page 8: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/8.jpg)
Superimposed preeclampsiaSuperimposed preeclampsia
New onset proteinuria New onset proteinuria >> 300mg/24 hours 300mg/24 hours in in hypertensive womenhypertensive women but no proteinuria but no proteinuria before 20 weeks gestasionbefore 20 weeks gestasion
Sign and symptoms severe preeclampsiaSign and symptoms severe preeclampsia
![Page 9: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/9.jpg)
Chronic HypertensionChronic HypertensionBP BP >> 140 mmHg before pregnancy or 140 mmHg before pregnancy or
diagnosed before 20 weeks gestationdiagnosed before 20 weeks gestation
![Page 10: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/10.jpg)
Risk Factor PreeclampsiaRisk Factor PreeclampsiaNulliparous (85%)Nulliparous (85%)Multiple pregnancyMultiple pregnancyHistory of chronic hypertensionHistory of chronic hypertensionMaternal age over 35 yearsMaternal age over 35 yearsObesitasObesitasSosial ekonomiSosial ekonomiGenetikGenetik
![Page 11: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/11.jpg)
Patophyisiology PreeclampsiaPatophyisiology Preeclampsia Maternal vascular deseaseMaternal vascular desease Faulty placentation (cacat)Faulty placentation (cacat) Excessive trophoblast (terlalu banyak)Excessive trophoblast (terlalu banyak)
Reduced uteroplacental perfusionReduced uteroplacental perfusion
Endothelial activationEndothelial activation
![Page 12: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/12.jpg)
Endothelial activation
Vasospasme Capillary Activation of coagulation
-Hypertension-Seizure-Oliguria-Abruption-Liver ischemia
EdemaProteinuriaHemoconcentration
Thrombocytopenia
![Page 13: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/13.jpg)
Mild PreeclampsiaMild Preeclampsia> 37 weeks gestasion : induction of labour> 37 weeks gestasion : induction of labour<< 37 weeks gestasion : 37 weeks gestasion :
- No medicationNo medication- No diuretikNo diuretik- Limitation activityLimitation activity- ANC 2x/weeks : Blood Pressure, proteinuria, ANC 2x/weeks : Blood Pressure, proteinuria,
refleks, fetal surveillancerefleks, fetal surveillance
![Page 14: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/14.jpg)
Management severeManagement severe1.1. Delivery is the cure for preeclampsiaDelivery is the cure for preeclampsia >> 35 weeks gestation : induction of labor 35 weeks gestation : induction of labor < 35 weeks gestation, no complication: < 35 weeks gestation, no complication: expectant expectant ( (
the hope that few more weeks in utero will reduce the hope that few more weeks in utero will reduce the risk of neonatal mortality and morbidity ) the risk of neonatal mortality and morbidity )
- Anti hypertensionAnti hypertension- Lung maturation : dexametason 12 mg/day Lung maturation : dexametason 12 mg/day - (sediaan: 6 mg), 2 days(sediaan: 6 mg), 2 days- Observation : Blood pressure, symptom impanding Observation : Blood pressure, symptom impanding
eclampsia, lab., fetal surveillance eclampsia, lab., fetal surveillance any disturbance any disturbance termination termination
![Page 15: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/15.jpg)
ManagementManagement2. Anti hypertensive Drug2. Anti hypertensive Drug- ββ-blocking agent : labetolol-blocking agent : labetolol- Calcium channel blocker : nifedipineCalcium channel blocker : nifedipine- ACE inhibitor ACE inhibitor
(Angiotensin-converting-enzyme): should be (Angiotensin-converting-enzyme): should be avoided : avoided : oligohidramnios, IUGR, pulmonary oligohidramnios, IUGR, pulmonary hypoplasia, etchypoplasia, etc
- Methyldopa : delayed onset (long-acting)Methyldopa : delayed onset (long-acting)
![Page 16: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/16.jpg)
ManagementManagement
33. . Preventive and control convulsionPreventive and control convulsion- MgSOMgSO44 : control convulsion without central : control convulsion without central
nervous system depressionnervous system depression- i.v : 4-6 g loading dose diluted in 100 ml of iv i.v : 4-6 g loading dose diluted in 100 ml of iv
fluid 15-20 min, maintenance 1-2 g/ hour in fluid 15-20 min, maintenance 1-2 g/ hour in 100 ml100 ml
- i.m : 4 g in both buttock, maintenance i.m : 4 g in both buttock, maintenance (stabilisasi 3 jam) 4g in one buttock,and then (stabilisasi 3 jam) 4g in one buttock,and then after 6h, 4g in other buttock.after 6h, 4g in other buttock.
![Page 17: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/17.jpg)
ManagementManagement
Before giving MgSOBefore giving MgSO44 : :1.1. The patellar refleks is presentThe patellar refleks is present2.2. Respiration are not depressed ( RR>16/min)Respiration are not depressed ( RR>16/min)3.3. Urin output > 100ml/4 hourUrin output > 100ml/4 hour
MgSoMgSo44 is discontinued 24 h after delivery is discontinued 24 h after delivery MgSOMgSO44 toxicity : respiratory depression, toxicity : respiratory depression,
paralysis, and arrestparalysis, and arrest Antidotum MgSOAntidotum MgSO44 : calcium gluconate : calcium gluconate
![Page 18: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/18.jpg)
ComplicationComplication
1.1. EclampsiaEclampsia
- Generalized tonic-clonic seizuresGeneralized tonic-clonic seizures- Coma without convulsionComa without convulsion- Cerebral edemaCerebral edema- ICUICU
![Page 19: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/19.jpg)
ComplicationComplication2. HELLP Syndrome2. HELLP Syndrome
- Hemolysis : fragmented erythrocyte, bilirubun > Hemolysis : fragmented erythrocyte, bilirubun > 1,2 ml/dL1,2 ml/dL
- Elevated Lever enzymes : SGOT > 72 IU/L, LDH Elevated Lever enzymes : SGOT > 72 IU/L, LDH > 600IU/L> 600IU/L
- Low Platelet count : < 100.000/mm3Low Platelet count : < 100.000/mm3- DICDIC- Tx : dexamethason 2 x 10 mg, then 2 x 5 mgTx : dexamethason 2 x 10 mg, then 2 x 5 mg
![Page 20: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/20.jpg)
ComplicationComplication
33. . Pulmonary edemaPulmonary edema
- Tachypneu/dyspneaTachypneu/dyspnea- Respiratory distressRespiratory distress- Severe hypoxemiaSevere hypoxemia- Diffuse rales in both lungDiffuse rales in both lung- ICU, ventilatorICU, ventilator- FurosemidFurosemid
![Page 21: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/21.jpg)
ComplicationComplication
4. Acut Renal Failure4. Acut Renal Failure5. Hepatic rupture5. Hepatic rupture6. Abruptio placentae6. Abruptio placentae7. Cerebral hemorrhage7. Cerebral hemorrhage8. Visual disturbances8. Visual disturbances
![Page 22: 4. Hipertensi Pada Kehamilan](https://reader036.vdokumen.com/reader036/viewer/2022062502/577c7d591a28abe0549e6c2e/html5/thumbnails/22.jpg)
TERIMAKASIHTERIMAKASIH