jessica
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7/17/2019 Jessica
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PREEKLAMPSI BERAT
JESSICA INTAN C 09700334
PEMBIMBING :
dr.M.HARIES,SP.OG
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Pendahulua
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Latar Belakang
● Angka kejadian preeklampsia berkisar antara5 – 15% dari seluruh kehamilan di seluruhdunia.
● Di Indonesia, preeklampsia dan eklampsiamasih merupakan salah satu penyebab utamamortalitas maternal dan perinatal
● Sampai saat ini etiologi preeklampsia belumdiketahui secara pasti
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Latar Belakang
● reeklampsia merupakan komplikasikehamilan yang ditandai dengan peningkatan
tekanan darah disertai proteinuria pada !anitahamil yang sebelumnya tidak mengalamihipertensi. "iasanya sindroma ini muncul padaakhir trimester kedua sampai ketiga
kehamilan.
● reeklampsia dapat berakibat buruk baik padaibu maupun janin yang dikandungnya.
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Tujuan
● Menge!"#$ %!&'r re($&' er)!d$n*!+ree&!-+($ er! +!d! &!(#( *!ng (ed!ngd$!"!(.
● Me-!nd$ng&!n +eneg!&!n d$!gn'($(
+ree&!-+($ er! +!d! &!(#( *!ng (ed!ngd$!"!( deng!n e'r$.
● Me-!nd$ng&!n !! !&(!n! +ree/!-+($!er! +!d! +!($en *!ng (ed!ng d$!"!(
deng!n e'r$.● Menge!"#$ #+!*! +en/eg!"!n +ree/!-+($!
er! +!d! &!(#( +ree/!-+($! er!,&"#(#(n*! +!d! +!($en *!ng (ed!ng
d$!"!(.
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TINJAUAN
PUSTAKA
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Definisi
● reeklampsia berat ialah preeklampsia dengantekanan darah sistolik # 1$ mm&g dan tekanandarah diastolik # 11 mm&g disertai proteinuria # 5
g' () jam atau kualitati* +(.
● reeklampsia berat dibagi menjadi- – reeklampsia berat tanpa impending eclampsia –
reeklampsia berat dengan impending eclampsia.
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Faktor Resiko
● Pr$-$gr!$d!, +r$-$+!ern$!(● H$+er+!(en'($(● 1-#r *!ng e&(r$-.● R$2!*! &e#!rg! +ern!" +ree/!-+($! e&!-+($!.● enyakitpenyakit ginjal dan hipertensi yang sudah ada sebelum
hamil● Re($&' +ree/!-+($! -en$ng&! d!r$ 4.3 +!d! $# "!-$
deng!n BMI &#r!ng d!r$ 59,6 &g- "$ngg! 53,3 +!d! $#"!-$ deng!n BMI e$" d!r$ 38 &g-
● !&'r $ng&#ng!n
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Etiologi
● In/asi tro*oblas abnormal pada pembuluh darahrahim.
● Intoleransi imunologi antara jaringan ibu dan
*etoplacental.● Te'r$ r!d$&! e!( d!n d$(%#ng($ end'e● 0aktor de*isiensi nutrisi.● 0aktor genetik
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Patogenesis
● asospasme● Akti/asi sel endotel
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Diagnosis
Digolongkan preeclampsia berat bila ditemukan satu ataulebih gejala sebagai berikut-.● Te&!n!n d!r!" ($('$& 5;0 --Hg d!n e&!n!n
d!r!" d$!('$/ 550 --Hg. Te&!n!n d!r!" $d!&#r#n -e(&$+#n $# "!-$ (#d!" d$r!2! d$ r#-!"(!&$ d!n (#d!" -en)!!n$ $r!" !r$ng.
● Pr'e$n#r$! e$" 8 g4 )!- !!# <= d!!-
+e-er$&(!!n &#!$!$%.● O$g#r$!, *!$# +r'd#&($ #r$n >800 //4 )!-.● Pen$ng&!!n &re!$n$n +!(-! ?<5. -gdL@.
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Diagnosis
●
G!ngg#!n $(#( d!n (erer!: +en#r#n!n &e(!d!r!n,n*er$ &e+!!, (&''-!, d!n +!nd!ng!n &!#r.
● N*er$ e+$g!(r$#- !!# n*er$ +!d! &#!dr!n &!n!n!!( !d'-en ?!&$! ereg!ngn*! &!+(#! G$(('n'e" &!ren! ne&r'($( "e+!'(e#er, $(&e-$!, d!nede-!@.
● G!ngg#!n %#ng($ "e+!r ?+en$ng&!!n &!d!r AST d!nALT@
● Ede-! +!r#+!r# d!n ($!n'($(.●
He-'$($( -$&r'!ng$'+!$ ?d$!nd!$ deng!n+en$ng&!!n LH@
● 2rombositopenia 341.'mm6● Per#-#"!n )!n$n $nr! #er$n *!ng er!-!.● S$ndr'- HELLP.
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Penatalaksanaan
Per!2!!n +ree&!-+($! er! d$!g$ -en)!d$ d#!#n(#r:● Per!-! !d!!" ren/!n! er!+$ +!d! +en*#$n*!:
*!$# er!+$ -ed$&!-en'(! deng!n +e-er$!n '!'!!n #n#& +en*#$n*!
● Ked#! !r# -enen#&!n ren/!n! ($&!+ er"!d!+&e"!-$!nn*!: *!ng erg!n#ng +!d! #-#r&e"!-$!nn*! d$!g$ , *!$#: – E&(+e&!$% K'n(er!$% : $! #-#r &e"!-$!n > 37
-$ngg#, !r$n*!: &e"!-$!n d$+er!"!n&!n (e!-!-#ng&$n (!-$ -e-er$ er!+$ -ed$&!-en'(!
– Akti*, agresi* - bila umur kehamilan + 7 minggu,artinya kehamilan diakhiri setelah mendapat terapi
medikamentosa untuk stabilisasi.
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Penatalaksanaan
a. encegahan 8ejang
● 2irah baring, tidur miring kiri● In*us 9: atau 9D5●
emberian anti kejang ;gS<) yang terbagi menjadidua tahap, yaitu - – L'!d$ng $n$$! d'(e : d'($( !2! – M!$nen!n/e d'(e : d'($( r#-!!n
● pasang 0oley catheter untuk monitor produksi urin
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Penatalaksanaan
b. Antihipertensi
● &anya diberikan bila tensi # 1='11 mm&g atau ;A #1($
●
"isa diberikan ni*edipin 1 – ( mg peroral, diulangsetelah menit, maksimum 1( mg dalam () jam● metildopa >(5mg'hr ● labetalol I 1>(mg● enurunan darah dilakukan secara bertahap -
– Pen#r#n!n !2! 8 d!r$ e&!n!n ($('$& – T!rge (e!n)#n*! !d!!" -en#r#n&!n e&!n!n
d!r!" > 5;0508 --Hg !!# MAP > 58
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Penatalaksanaan
/. $#re$&#-
● T$d!& d$er$&!n (e/!r! r#$n &!ren! -en$-#&!ne%e& –
;emperberat penurunan per*usi plasenta – ;emperberat hipo/olemia – ;eningkatkan hemokonsentrasi
● Ind$&!($ +e-er$!n d$#re$&#- : – Ede-! +!r# – P!*!" )!n#ng &'nge($% – Ede-! !n!(!r&!
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Komplikasi
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Komplikasi
Penyulit Ibu
●
SS - – Perd!r!"!n Inr!&r!n$! – 2hrombosis /ena sentral – &ipertensi ensephalopati – ?dema cerebri – ?dema retina – ;acular atau retinal
detachment – 8ebutaan corte>
● G!(r'$ne($n!"e+!$& : – S#/!+(#!r "e-!'-!
"e+!r – 9uptur kapsul hepar – Ascites
●
G$n)! : – G!g! g$n)! !&# – @ekrosis 2ubular Akuta
● He-!''g$& : – IC –
2rombositopenia● K!rd$'+#-'n!: – Ede-! +!r# – Arrest napas – ardiac arrest – Iskemia miokardium
K lik i
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Komplikasi
Penyulit Janin
● Inr!#er$n %e! gr'2" re(r$/$'n● S'#($' +!(en!● Pre-!#r$!(● S$ndr'-! d$(re( n!+!(● 8ematian janin intrauterin● Ke-!$!n ne'n!! +erd!r!"!n $nr!enr$&#er● Ne/r'$D$ng ener'/'$$(● Se+($(● Cerer! +!(*
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Laporan
Kasus
Identitas
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Reg : ;7649N!-! : N*.
1-#r : 0 !"#nS!#( : Men$&!" 5F, 5 !"#nPe&er)!!n : IRTPend$d$&!n : er!&"$r SS#!-$ : Tn. N!($r1-#r : 8 !"#nPe&er)!!n : )#!!n d$ 2!r#ngA!-! : Kr!)!n 0304 S$*!r Re-!ng P!(#r#!nTg MRS : 906058
Identitas
ubyektif
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● &e#"!n #!-! : &!&$ &!n!n &$r$ eng&!&●
P!($en &'nr' &e +'$ '(g*n deng!n &e#"!n &!&$&!n!n &$r$ eng&!& (e)!& 5 -$ngg# *!ng !#. eng!nd$!gn'(! d!r$ +'$ G5P0000A000 gr 3940 -gg TH =PEB
●
+!($en -er!(! "!-$ 9 #!n, +er# &en/eng&en/eng?@, &e#!r /!$r!n d!r$ )!!n !"$r ?@, d!r!" ?@, end$r ?@,+#($ng ?@, +!nd!ng!n &!#r ?@, n*er$ ## "!$ ?@.
ubyektif
ubyektif
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● Mer!(!&!n ger!&!n )!n$n (e)!& "!-$ 4 #!n (!-+!$(e&!r!ng.
● P!($en !"# e&!n!n d!r!"n*! $ngg$ !r# "!r$ $n$.See#-n*! (e$!+ &'n' (e!# n'r-!.
● R$2!*! +e*!&$ d!"## "$+eren($, M, !(-!, !erg$ '!d!n -!&!n!n, d!n &e)!ng&e)!ng (!! "!-$ $d!& !d!.
●
RPL: H!-$ $n$● ANC: &'nr' r#$n 5 #!n (e&!$ &e $d!n, &e$&!
-e-!(#&$ 9 #!n r#$n 5 -$ngg# (e&!$ &e +'$ '(g*nRS1 B!ng$
● HPHT: 85054● KB ?@
ubyektif
K1 : !$& CM !byektif
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Ad : T1 34 /-letak - bujur :eopord I - presentasi bokongLe'+'rd II : +#ngg#ng d$ &$r$ $#Le'+'rd III : +re(en!($ &e+!!Le'+'rd I : &e+!! &'nergenBJA :5.55.5
TBJ : 3450 grHIS : ?@T: 05 /-, e%% 8, H 5, &e?=@, erd!"## &e+!!, den'-:(de, LP n'r-!.
K1 : !$&, CMTB : 5;9 /-BB : 90 &gS :T : 560550 --HgN : 60F -en$RR : 0F -en$2a> - $.B
KL : !n , $/ T"' : / S5,S #ngg!,$($ng ?@, + R" " Ode-! eFre-$!( :
eF. A!(
eF. B!2!" ==
!byektif
Pemeriksaan Penunjang
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"asil Laboratorium
BC : 55900HB : 5,3
1rCr : 580,9GA : 68OTPT : 859SE :584,33,9550,5
1L : A =3
● baseline rate 1 bpm● /ariability + 5 bpm● Akselerasi - 36● deselerasi - 36
Pemeriksaan Penunjang
Pemeriksaan Penunjang
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Pemeriksaan Penunjang
● 2ampak janin intrauteri 2'&● letak bujur kepala di ba!ah● "D- B,=( cm● A - 1,( cm● 0: - 7,( cm● ?0C - 17) g● A0I - cukup● plasenta lengkap di caput
anterior matur gr III
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G5 P0000 A000 gr 3940 -gg TH$nr!#er$ $d!& $n+!r#= +re e&!-+($! er!= TBJ 3574
A((e((-en
Planning
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g
Re(#($!($ $nr! #er$ne:● T$d#r -$r$ng &e
!er! &$r$● O -!(&er 50 -● I R 8 5
+-●
P!(!ng &!eer
-en/eg! &e)!ng :● In). SM %# d'(e
– SM 0 4 g $ +e!n – SM 40 50 g $-,
g# deF($n -!($ng
-!($ng 8 g● :ajut S; maintenance – SM 40 8 g , g#
deF($n +ern ;)!-(e!-! 4 )!-.
rencana terminasi per/aginamdeng!n r$+en$ng -$('+r'(' 80-/g 'r! ;)!- (!-+!$ PS < ;,
!n)# O (ee!" 5 )!- -$('+r'(', O 5!-+ d!!- 800// RL. Se!-! +e-er$!n O +r' $ner-$en NST. $! (#d" -e-!(#&$ &!!II d$ +er/e+! deng!n 'r(e+.
!n$ "$+eren($ N$%ed$+$n 3F50-g -e$d'+! 3F80-g
Planning Diagnosis# D:, :, <2'2, "@'S8, S?, EDA
Planning Terapi:
;< - obser/asi S, keluhan, his, DFF, produksi urine, balance cairan ' $ jam,
re*le> patella, tanda – tanda impending eclampsia.
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!ut$ome
ada tanggal Agustus (15, pukul 1B.1 lahir bayi lakilakidengan berat = gr, panjang badan 5 cm, AS 7=, ketubanmeconeal
c to e t t e t t e text
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