k16 - hipertensi dalam kehamilan (rhr).ppt

7/24/2019 K16 - HIPERTENSI DALAM KEHAMILAN (RHR).ppt

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R. HARYONO ROESHADI,R. HARYONO ROESHADI,


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KLASIFIKASI :Report on the National High Blood Pressure Education

Program Woring !roup on High Blood Pressure in

Pregnanc" #A$%! &ol '():S'* $ul" +,,,-

HIPERTENSI GESTASIONAL :

DIDAPATKAN DESAKAN DARAH 140/90 mmHg PERTAMA

KALINYA PD KEHAMILAN, TDK DISERTA DGN PROTEINURIA

DAN DESAKAN DARAH KEMBALI NORMAL < 12 MGG PASA

PERSALINAN


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PREELAMSIA :

KRITERIA MINIMUM

DESKAN DARAH 140/90 mmHg UMUR KEHAMILAN 20 MGG,DISERTAI PROTEINURIA !00 mg/24 "AM ATAU DIPSTIK 1 #

ELAMSIA

KE"ANG2 PADA PREELAMPSIA DISERTAI KOMA


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HIPERTENSI KRONIK DGN SUPERIMPOSED PREELAMPSIA

PROTEINURIA !00 MG/24 "AM PD $ HAMIL YG SUDAH

MENGALAMI HIPERTENSI SEBELUMNYA% PROTEINURIA TIMBULSETELAH KEHAMILAN 20 MGG

HIPERTENSI KRONIK

DITEMUKANNYA DESAKAN DARAH 140/90 mmHg, SEBELUM

KEHAMILAN ATAU SEBELUM KEHAMILAN 20 MGG DAN TDK

MENGHILANG SETELAH 12 MGG PASA PERSALINAN


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IN.R%/01.I%N :

INDUED BY PREGNANY

DISEASE O& THEORIES

LINIAL MANI&ESTATION : HYPERTENSION 'ITH OR 'ITHOUT

ORGAN DYS&UNTION / &AILURE

THIRD LEADING AUSE O& MATERNAL MORTALITY

MORTALITY RATE : 1(0%000 'OMEN A YEAR 'ORLD

'IDE


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YEARYEAR HOSPITALHOSPITAL PERCENTAGEPERCENTAGE AUTHORAUTHOR

1993 19971993 1997

1996 19971996 1997

1995 19981995 1998

2000 20022000 2002

20022002

RSPMRSPM

12 HOSPITALS12 HOSPITALS

RS. H.S.RS. H.S.

RSHAM RSPMRSHAM RSPM

RSCMRSCM

5,755,75

0,8 - 140,8 - 14

13,013,0

7,07,0

9,179,17

SIMANUNTA! .SIMANUNTA! .

TRI"A#ONO A.TRI"A#ONO A.

MEI$IAMEI$IA

GIRSANG. EGIRSANG. E

PRIYATINIPRIYATINI

IN1I/EN1EIN1I/EN1E

PE/E : 2) * 9) O& ALL PREGNANT 'OMENPE/E : 2) * 9) O& ALL PREGNANT 'OMEN

IN SE+ERAL HOSPITAL IN INDONESIAIN SE+ERAL HOSPITAL IN INDONESIA


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E.I%L%!2 : N%. F0LL2 KN%WNE.I%L%!2 : N%. F0LL2 KN%WN

RISK &ATORS :RISK &ATORS :

NULLI PARITY / TEENAGE PREGNANYNULLI PARITY / TEENAGE PREGNANY

HISTORY O& PRE+IOUS PREGNANYHISTORY O& PRE+IOUS PREGNANY

&AMILY HISTORY O& PE/E&AMILY HISTORY O& PE/E

MULTIPLE GESTATIONMULTIPLE GESTATION

PREEISTING HYPERTENSION / RENAL DISEASEPREEISTING HYPERTENSION / RENAL DISEASE

D%M, ANTI PHOSPOLIPID ANTIBODYD%M, ANTI PHOSPOLIPID ANTIBODY

HYDROPS &ETALISHYDROPS &ETALIS

HYDATIDI&ORM MOLESHYDATIDI&ORM MOLES

URYNARY TRAT IN&ETIONURYNARY TRAT IN&ETION


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PA.H%!ENESE :PA.H%!ENESE :

ONTRO+ERSION : THE DISEASE O& THEORIESONTRO+ERSION : THE DISEASE O& THEORIES

IMMUNITY, GENETIC

VASC. DISEASE

TROPHOBLAST

INADEQUATE TROPHOB. INVASION TO

SPIRAL ARTERY OF PLACENTA

INSUFF, PLACENTA

HYPOXIA IUGR

OXYDATIVE STRESS

ENDOTHELIAL DYSFUNCTION

CIRCULATING FACTOR(S)

CYTOKINES LIPID

(IL-6, TNF-) PEROXIDES

NEUTROPHIL

ACTIVATION

PLATELET

ACTIVATION


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ENDOTHELIAL DYSFUNCTION

BLOOD

THROMBOCYTOPENIA COAGULAPATHY

ALTERED VASCULAR

PERMEABILITY

PERIPHERAL OEDEMA

PULMONARY OEDEMA

SYSTEMIC

VASOCONSTRICTION

HYPERTENSION

KIDNEYS

HYPERURICAEMIA PROTEINURIA

RENAL FAILURE

LIVER

ABNORMAL FUNCTION

TESTS HAEMORRHAGE

CNS EYES

SEI!URES

CORTICAL BLINDNESS

RETINAL DETACHMENT" HAEMORRHAGE


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1LINI1AL 1LASSIFI1A.I%N:1LINI1AL 1LASSIFI1A.I%N:

PREELAMPSIAPREELAMPSIA ** MILDMILD

** SE+ERESE+ERE

IMPENDING ELAMPSIAIMPENDING ELAMPSIA

ELAMPSIAELAMPSIA

HELLP SYNDROMEHELLP SYNDROME


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3IL/ PREE1LA3PSIA%

BP 140/90 mmHg A&TER 20 'EEKS GESTATION

PROTEINURIA !00 mg/ 24 H OR 1# DIPSTIK

'ITH OR 'ITHOUT OTHER SYMPTOMS AND SIGN


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SE&ERE PREE1LA3PSIA

BP 1-0/110 mmHG

PROTEINURIA 2%0 g. / 24 H OR 2 # DIPSTIK

HEADAHE, +ISUAL OR EREBRAL DISTURBANE

EPIGASTRI PAIN

OLIGURIA : < 400 (00 / 24 HOURS HYPER RE&LE, MOTORI EITATION, IMPAIRED

ONSIOUSNESS, SUDDEN DETERIORATION

PLATELETS OUNT < 1000%000 / mm!

BILIRUBIN 1,2 mg / DL

LDH -00 IU/L

SGOT 0 mg/DL


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I3PEN/IN! E1LA3PSIA

SE+ERE PREELAMPSIA 'ITH :

HEADAHE

NAUSEA AND +OMITING

BLURRED +ISION, SOTOMA, IMPAIRED ONSIOUSNESS,

SUDDEN DETERIORATION

EPIGASTRI PAIN


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E1LA3PSIAE1LA3PSIA

SE+ERE PREELAMPSIA # ON+ULSIONSE+ERE PREELAMPSIA # ON+ULSION

IS THE LEADING AUSE O& (0%000 MATERNAL MORTALITYIS THE LEADING AUSE O& (0%000 MATERNAL MORTALITY

A YEAR 'OLRD 'IDEA YEAR 'OLRD 'IDE

() OURRED ANTEPARTUM AND 2() POST PARTUM() OURRED ANTEPARTUM AND 2() POST PARTUM

40) O& SEIURES OUR BE&ORE HOSPITALIATION40) O& SEIURES OUR BE&ORE HOSPITALIATION

EREBRAL HAEMORRHAGE, PULMONARY EDEMAEREBRAL HAEMORRHAGE, PULMONARY EDEMA ARE THEARE THE

MOST OMMON OMPLIATIONMOST OMMON OMPLIATION


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HELLP S2N/R%3EHELLP S2N/R%3E

OMPLIATION O& SE+ERE PREELAMPSIAOMPLIATION O& SE+ERE PREELAMPSIA

10*1() DIRETLY &ROM PREGNANY10*1() DIRETLY &ROM PREGNANY

3ANA!E3EN. %F PREE1LA3PSIA3ANA!E3EN. %F PREE1LA3PSIA

ADE3UAT AND PROPER PRENATAL AREADE3UAT AND PROPER PRENATAL ARE

IDENTI&IATION O& 'OMEN AT HIGH RISKIDENTI&IATION O& 'OMEN AT HIGH RISK

EARLY DETETION BY THE REOGNATION O& LINIALEARLY DETETION BY THE REOGNATION O& LINIAL

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

THE PROGRESSION O& ONDITION TO SE+ERE STATETHE PROGRESSION O& ONDITION TO SE+ERE STATE


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MATERNAL AND PERINATAL OUTOME IN 'OMEN 'ITH MILDMATERNAL AND PERINATAL OUTOME IN 'OMEN 'ITH MILD

PREELAMPSIA, !- 'EEKS GESTATION ARE USUALLYPREELAMPSIA, !- 'EEKS GESTATION ARE USUALLY

&A+OURABLE&A+OURABLE

MATERNAL AND PERINATAL OUTOMES DEPEND ON :MATERNAL AND PERINATAL OUTOMES DEPEND ON :

GESTATIONAL AGE AT TIME O& DISEASE ONSETGESTATIONAL AGE AT TIME O& DISEASE ONSET

SE+ERITY O& DISEASESE+ERITY O& DISEASE

3UAITY O& MANAGEMENT3UAITY O& MANAGEMENT

PRESENE OR ABSENE O& PRE*EISTING MEDIALPRESENE OR ABSENE O& PRE*EISTING MEDIAL

DISORDERSDISORDERS


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3IL/ 4 PREE1LA3PSIA3IL/ 4 PREE1LA3PSIA

AMBULATORY AREAMBULATORY ARE

BED REST : NOT NEESSARILYBED REST : NOT NEESSARILY

REGULAR DIET, NO SALT RESTRITIONREGULAR DIET, NO SALT RESTRITION

PRENATAL +ITAMINPRENATAL +ITAMIN

NO OTHER MEDIATION : ANTI HYPERTENSI+E,NO OTHER MEDIATION : ANTI HYPERTENSI+E,

SEDATI+E, DIURETISSEDATI+E, DIURETIS

ANTENAL +ISIT : E+ERY 'EEKANTENAL +ISIT : E+ERY 'EEK


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H%SPI.AL 1AREH%SPI.AL 1ARE

PERSISTENT HYPERTENSION MORE THAN 2 'EEKSPERSISTENT HYPERTENSION MORE THAN 2 'EEKS

PERSISTENT PROTENURIA MORE THAN 2 'EEKSPERSISTENT PROTENURIA MORE THAN 2 'EEKS

ABNORMAL LABORATORY TESTABNORMAL LABORATORY TEST

ABNORMAL &ETAL GRO'THABNORMAL &ETAL GRO'TH

ONE OR MORE SIGN AND SYMPTOM SE+ERE PEONE OR MORE SIGN AND SYMPTOM SE+ERE PE


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OBSTETRIC MANAGEMENTOBSTETRIC MANAGEMENT

GESTATIONAL AGE # $% &EEKSGESTATIONAL AGE # $% &EEKS

'' SIGN AND SYMPTOM ARE NOT &ORSENEDSIGN AND SYMPTOM ARE NOT &ORSENED

MAINTAIN UNTIL TERMMAINTAIN UNTIL TERM

GESTATIONAL AGE $% &EEKSGESTATIONAL AGE $% &EEKS

'' &AIT UNTIL THE ONSET OF LABOR&AIT UNTIL THE ONSET OF LABOR

'' CERVIX IS FAVORABLE, INDUCTION OF LABORCERVIX IS FAVORABLE, INDUCTION OF LABOR


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SE&ERE PREE1LA3PSIASE&ERE PREE1LA3PSIA

MEDICAL TREATMENTMEDICAL TREATMENT

OBSTETRIC MANAGEMENT OBSTETRIC MANAGEMENT

CONSERVATIVE -CONSERVATIVE - PREGNANCYPREGNANCY $% &EEKS$% &EEKS

ACTIVEACTIVE -- PREGNANCYPREGNANCY $% &EEKS$% &EEKS

-- FETAL INDICATIONFETAL INDICATION -- MATERNAL INDICATIONMATERNAL INDICATION


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3E/I1AL .REA.3EN. :3E/I1AL .REA.3EN. : HOSPITALI!EHOSPITALI!E

TOTAL BED RESTTOTAL BED REST

FLUID THERAPY RINGER LACTATE, DEXTROSE *+.FLUID THERAPY RINGER LACTATE, DEXTROSE *+.

M SOM SO IVIV

ANTI HYPERTENSION ANTI HYPERTENSION

HYDRALA!INHYDRALA!IN

LABETALOLLABETALOL

NIFEDIPINENIFEDIPINE / 0 1/ 2 ORALLY EVERY 3 - H,/ 0 1/ 2 ORALLY EVERY 3 - H,

MAX 1/ 2 1 H457MAX 1/ 2 1 H457

DIURETICDIURETIC NOT RECOMMENDED NOT RECOMMENDED

ANTI OXYDANT N-ACETYL CYSTEINANTI OXYDANT N-ACETYL CYSTEIN

CORTICOSTEROID 8 LUNG MATURITYCORTICOSTEROID 8 LUNG MATURITY $ &EEKS$ &EEKS


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%BS.E.RI1 3ANA!E3EN.%BS.E.RI1 3ANA!E3EN.

ONSER+ATI+E MANAGEMENT:ONSER+ATI+E MANAGEMENT:

GOALGOAL :: TO IMPRO+E IN&ANT OUTOME,TO IMPRO+E IN&ANT OUTOME,

'ITHOUT OMPROMISING THE MOTHER'ITHOUT OMPROMISING THE MOTHER

PREGNANYPREGNANY

! 'EEKS, IMPENDING ELAMPSIA *5! 'EEKS, IMPENDING ELAMPSIA *5

ATI+E MANAGEMENT : TO TERMINATE THE PREGNANYATI+E MANAGEMENT : TO TERMINATE THE PREGNANY

INDIATIONINDIATION

&ETAL&ETAL :: ** PREGNANYPREGNANY

! 'EEKS! 'EEKS

** IUGR AND ABNORMALIUGR AND ABNORMAL

BIOPHYSIAL PRO&ILEBIOPHYSIAL PRO&ILE


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MATERNALMATERNAL :: ** PERSISTENT HYPERTENTIONPERSISTENT HYPERTENTION** IMPENDING ELAMPSIAIMPENDING ELAMPSIA

** OMPLIATION : HELLP SYNDROME,OMPLIATION : HELLP SYNDROME,

ABRUPTIO PLA%, OLIGURIAABRUPTIO PLA%, OLIGURIA

ROUTE O& DELI+ERY :ROUTE O& DELI+ERY :

66 +AGINAL DELI+ERY IS PRE&ERABLE THAN S%+AGINAL DELI+ERY IS PRE&ERABLE THAN S%


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E1LA3PSIA : PE 5 1%N&0LSI%NE1LA3PSIA : PE 5 1%N&0LSI%N

BASI MANAGEMENT :BASI MANAGEMENT :

ONTROL THE AIR'AY, BREATHING, IRULATION AB5ONTROL THE AIR'AY, BREATHING, IRULATION AB5

STABILIE THE MOTHERSTABILIE THE MOTHER

ONTROL ON+ULSIONONTROL ON+ULSION

ORRET MATERNAL HYPOEMIA / AIDEMIAORRET MATERNAL HYPOEMIA / AIDEMIA

PRE+ENT OMPLIATION : HYPERTENSION RISISPRE+ENT OMPLIATION : HYPERTENSION RISIS

TERMINATE PREGNANYTERMINATE PREGNANY

MEDIAL TREATMENT :MEDIAL TREATMENT :

SAME AS SE+ERE PREELAMPSIASAME AS SE+ERE PREELAMPSIA


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1%3PLI1A.I%N : P6E AN/ E1LA3PSIA1%3PLI1A.I%N : P6E AN/ E1LA3PSIA

MOTHERMOTHER "A"Y"A"Y

HELLP SYN&ROMEHELLP SYN&ROME

LI'ER RUPTURE&LI'ER RUPTURE&

PULMONARY E&EMAPULMONARY E&EMA

RENAL (AILURERENAL (AILURE

A"RUPTIO PLACENTAEA"RUPTIO PLACENTAE

&IC&IC

CERE"ROL 'ASCULER ACCI&ENTCERE"ROL 'ASCULER ACCI&ENT

MATERNAL &EATHMATERNAL &EATH

IUGRIUGR

PREMATURE LA"ORPREMATURE LA"OR

INTRA CRANIAL HAEMORRHAGEINTRA CRANIAL HAEMORRHAGE

CERE"RAL PALSYCERE"RAL PALSY

PNEUMO THORA)PNEUMO THORA)

IU(&IU(&


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HIPER.ENSI KR%NIK /ALA3 KEHA3ILANHIPER.ENSI KR%NIK /ALA3 KEHA3ILAN

DE&INISI KLINIK:DE&INISI KLINIK:

HIPERTENSI YG DIDAPAT SEBELUM KEHAMILAN ATAUHIPERTENSI YG DIDAPAT SEBELUM KEHAMILAN ATAU

SEBELUM UMUR KEHAMILAN 20 MGG DAN HIPERTENSI TDKSEBELUM UMUR KEHAMILAN 20 MGG DAN HIPERTENSI TDK

MENGHILANG SETELAH 12 MGG PASA PERSALINANMENGHILANG SETELAH 12 MGG PASA PERSALINAN

ETIOLOGI HIPERTENSI KRONIK DALAM KEHAMILANETIOLOGI HIPERTENSI KRONIK DALAM KEHAMILAN

PRIMER IDIOPATIK5 : 90 )PRIMER IDIOPATIK5 : 90 )

SEKUNDER : 10 ), YG BERHUBUNGAN DGN PENY%SEKUNDER : 10 ), YG BERHUBUNGAN DGN PENY%

GIN"AL, PENY% ENDOKRIN 7m5, PENY% HIPERTENSI DANGIN"AL, PENY% ENDOKRIN 7m5, PENY% HIPERTENSI DAN

+ASKULER+ASKULER


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DIAGNOSISDIAGNOSIS

BERDASARKAN RISIKO :BERDASARKAN RISIKO :

** RISIKO RENDAH :RISIKO RENDAH : HIPERTENSI RINGAN TANPA DISERTAIHIPERTENSI RINGAN TANPA DISERTAI

KERUSAKAN ORGANKERUSAKAN ORGAN

** RISIKO TINGGIRISIKO TINGGI :: HIPERTENSI BERAT / HIPERTENSIHIPERTENSI BERAT / HIPERTENSI

RINGAN DISERTAI PERUBAHANRINGAN DISERTAI PERUBAHAN

PATOLOGIS, KLINIS MAUPUN BIOLOGIPATOLOGIS, KLINIS MAUPUN BIOLOGI

KERUSAKAN ORGANKERUSAKAN ORGAN

KRITERIA RISIKO TINGGI PD HIPERTENSI KRONIK DLMKRITERIA RISIKO TINGGI PD HIPERTENSI KRONIK DLM

KEHAMILANKEHAMILAN** HIPERTENSI BERAT :HIPERTENSI BERAT :

DESAKAN SISTOLIK 1-0 mmHg DANDESAKAN SISTOLIK 1-0 mmHg DAN

DESAKAN DIASTOLIK 110 mmHg, SEBELUM 20 MGGDESAKAN DIASTOLIK 110 mmHg, SEBELUM 20 MGG

KEHAMILANKEHAMILAN


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** HIPERTENSI RINGAN < 20 MGG KEHAMILAN DGN :HIPERTENSI RINGAN < 20 MGG KEHAMILAN DGN :

PERNAH PREELAMPSIAPERNAH PREELAMPSIA

UMUR IBU 40 THNUMUR IBU 40 THN

HIPERTENSI 4 THNHIPERTENSI 4 THN

ADANYA KELAINAN GIN"ALADANYA KELAINAN GIN"AL

ADANYA DIABETES MELLITUS KLAS B KLAS &5ADANYA DIABETES MELLITUS KLAS B KLAS &5

KARDIOMIOPATIKARDIOMIOPATI

MEMINUMI OBAT ANTI HIPERTENSI SEBELUM HAMILMEMINUMI OBAT ANTI HIPERTENSI SEBELUM HAMIL


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KLASI&IKASI HIPERTENSI KRONIK

KLASI&IKASI SISTOLIK mmHg5 DIASTOLIK mmHg5NORMAL

PREEHIPERTENSI

HIPERTENSI STADIUM I

HIPERTENSI STADIUM II

< 120

120 1!9

140 1(9

1-0

< 80

80 89

90 99

110

(the 7thReport of the Joint National Committee (JNC 7)

MIMs Cardiovascular Guide th. 200 ! 200")

PENGELOLAAN HIPERTENSI KRONIK DLM KEHAMILAN


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PENGELOLAAN HIPERTENSI KRONIK DLM KEHAMILAN:PENGELOLAAN HIPERTENSI KRONIK DLM KEHAMILAN:

TU"UAN PENGOBATAN HIPERTENSI KRONIK DLMTU"UAN PENGOBATAN HIPERTENSI KRONIK DLM KEHAMILANKEHAMILAN

** MENEKAN RISIKO PD IBUMENEKAN RISIKO PD IBU

KENAIKAN DESAKAN DARAHKENAIKAN DESAKAN DARAH

** MENGHINDARI PEMBERIAN OBAT2 YG MEMBAHAYAKANMENGHINDARI PEMBERIAN OBAT2 YG MEMBAHAYAKAN

"ANIN"ANIN

PEMERIKSAAN LABORATORIUMPEMERIKSAAN LABORATORIUM

PEMERIKSAAN TEST5 KLINIK SPESIALISTIK :PEMERIKSAAN TEST5 KLINIK SPESIALISTIK :

** EGEG

** EHOARDIOGRAPHYEHOARDIOGRAPHY

** OPHTALMOLOGYOPHTALMOLOGY

** USG GIN"ALUSG GIN"AL


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PEMERIKSAAN TEST5 LABORATORIUMPEMERIKSAAN TEST5 LABORATORIUM

** &UNGSI GIN"AL :&UNGSI GIN"AL : REATININE SERUM BUN SERUM, ASAMREATININE SERUM BUN SERUM, ASAM

URAT, PROTEINURIA 24 "AMURAT, PROTEINURIA 24 "AMPEMERIKSAAN PROTEINURIA SEARAPEMERIKSAAN PROTEINURIA SEARA

PERIODIKPERIODIK

** &UNGSI HEPAR&UNGSI HEPAR

** HEMATOLOGIKHEMATOLOGIK :: H, HEMATOKRIT, TROMBOSITH, HEMATOKRIT, TROMBOSIT

PEMERIKSAAN KESE"AHTERAAN "ANINPEMERIKSAAN KESE"AHTERAAN "ANIN


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PEMERIKSAAN KESE"AHTERAAN "ANINPEMERIKSAAN KESE"AHTERAAN "ANIN

ULTRASONOGRAPHY :ULTRASONOGRAPHY :

** USG UTK DATA DASAR DIAMBIL 18*20 MGG KEHAMILANUSG UTK DATA DASAR DIAMBIL 18*20 MGG KEHAMILAN

** DIULANG PD UMUR KEHAMILAN 28*!2 MGG DAN DIIKUTIDIULANG PD UMUR KEHAMILAN 28*!2 MGG DAN DIIKUTI

SETIAP BLNSETIAP BLN

** BILA DIURIGAI IUGR DI MONITOR DGN NST DAN PRO&ILBILA DIURIGAI IUGR DI MONITOR DGN NST DAN PRO&IL

BIO&ISIKBIO&ISIK

HIPERETENSI KRONIK DLM KEHAMILAN DGN PENYULITHIPERETENSI KRONIK DLM KEHAMILAN DGN PENYULIT

KARDIO+ASKULER ATAU PENY% GIN"AL PERLU MENDAPATKARDIO+ASKULER ATAU PENY% GIN"AL PERLU MENDAPAT

PERHATIAN KHUSUSPERHATIAN KHUSUS

PENGOBATAN MEDIKAMENTOSAPENGOBATAN MEDIKAMENTOSA


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PENGOBATAN MEDIKAMENTOSAPENGOBATAN MEDIKAMENTOSA

INDIKASI PEMBERIAN ANTIHIPERTENSI:INDIKASI PEMBERIAN ANTIHIPERTENSI:

RISIKO RENDAH HIPERTENSI:RISIKO RENDAH HIPERTENSI:

** IBU SEHAT DGN DESAKAN DIASTOLIK MENETAPIBU SEHAT DGN DESAKAN DIASTOLIK MENETAP 100100

mmHgmmHg

** DGN DIS&UNGSI ORGAN DAN DESAKAN DIASTOLIKDGN DIS&UNGSI ORGAN DAN DESAKAN DIASTOLIK

9090

mmHgmmHg

OBAT ANTIHIPERTENSIOBAT ANTIHIPERTENSI

** PILIHAN PERTAMAPILIHAN PERTAMA : METHYLDOPA : 0%(*!%0 g/., DIBAGI DLM: METHYLDOPA : 0%(*!%0 g/., DIBAGI DLM

2*! DOSIS%2*! DOSIS% : NE&EDIPINE : !0*120 g/., DLM SLO'*: NE&EDIPINE : !0*120 g/., DLM SLO'*

RELEASE TABLETRELEASE TABLET

PENGELOLAAN TERHADAP KEHAMILANPENGELOLAAN TERHADAP KEHAMILAN


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PENGELOLAAN TERHADAP KEHAMILANPENGELOLAAN TERHADAP KEHAMILAN

SIKAP TERHDP KEHAMILANNYA PD HIPERTENSI KRONIKSIKAP TERHDP KEHAMILANNYA PD HIPERTENSI KRONIK

RINGAN : KONSER+ATI&RINGAN : KONSER+ATI&

DILAHIRKAN SEDAPAT MUNGKINDILAHIRKAN SEDAPAT MUNGKIN

PER+AGINAM PD KEHAMILAN ATERM%PER+AGINAM PD KEHAMILAN ATERM%

SIKAP TERHDP KEHAMILAN PD HIPERTENSI KRONIK BERAT :SIKAP TERHDP KEHAMILAN PD HIPERTENSI KRONIK BERAT :

AKTI+AKTI+

SEGERA KEHAMILAN DIAKHIRI DITERMINASI5SEGERA KEHAMILAN DIAKHIRI DITERMINASI5

ANESTESI : REGIONAL ANESTESIANESTESI : REGIONAL ANESTESI

HIPERTENSI KRONIK DGN SUPERIMPOSED PREELAMPSIAHIPERTENSI KRONIK DGN SUPERIMPOSED PREELAMPSIA

PENGELOLAAN HIPERTENSI KRONIK DGN SUPERIMPOSEDPENGELOLAAN HIPERTENSI KRONIK DGN SUPERIMPOSED

PREELAMPSIA SAMA DGN PENGELOLAAN PREELAMPSIAPREELAMPSIA SAMA DGN PENGELOLAAN PREELAMPSIA

BERAT%BERAT%


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HELLP SYN&ROMEHELLP SYN&ROME

PREGNANY

HYPERTENSION AND

PROTEINURIA

PREELAMPSIA

HELLP SYNDROME

10*14) ASE


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HELLP S2N/R%3EHELLP S2N/R%3E

&IRST DISRIBED BY 'EINSTEIN 1982:&IRST DISRIBED BY 'EINSTEIN 1982:

ARONYM O& :ARONYM O& : HH :: HEMOLYSISHEMOLYSIS

ELEL :: ELE+ATED LI+ER ENYMELE+ATED LI+ER ENYM

LPLP :: LO' PLATETLED OUNTLO' PLATETLED OUNT

INIDENE :INIDENE : 2)*12) AMONG PATIENTS 'ITH2)*12) AMONG PATIENTS 'ITH

PREELAMPSIA%PREELAMPSIA%

!0) OURS IN POSTPARTUM!0) OURS IN POSTPARTUM

1RI.ERI /I !N% .I1


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1RI.ERIA /IA!N%S.I11RI.ERIA /IA!N%S.I1LABORATORY FINDING:LABORATORY FINDING:

HEMOLYSISHEMOLYSIS

ABNORMAL PERIPHERAL SMEAR : SHISTOYTES ANDABNORMAL PERIPHERAL SMEAR : SHISTOYTES ANDBURR ELLSBURR ELLS

TOTAL BILIRUBIN LE+EL 1,2 mg/D;TOTAL BILIRUBIN LE+EL 1,2 mg/D;

LATATE DEHYDROGENASE LE+EL -00LATATE DEHYDROGENASE LE+EL -00

/L/L

ELE+ATED LI+ER &UTIONELE+ATED LI+ER &UTION

SGOT LE+ELSGOT LE+EL

00

/ L LDH5/ L LDH5

LATATE DEHYDROGENASE LE+EL -00LATATE DEHYDROGENASE LE+EL -00

/L/L

LO' PLATELET OUNTLO' PLATELET OUNT

PLATELET OUNT < 100%000/mPLATELET OUNT < 100%000/m!!

THE LABORATORY DIAGNOSTI RITERIA USED AT THE UNI+ERSITY O& TENNESSEE

DI+ISION O& MATERNAL &ETAL MEDEINE, MEMPHIS TN% 'ITLIN AND SIBAI 19995

CLASSIFICATION BASED ON PLATELET COUNTCLASSIFICATION BASED ON PLATELET COUNT


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CLASS I PLATELETCLASS I PLATELET */.///2*/.///2$$

&ITH &ITH LDHLDH

6//6//

ULUL

SGOTSGOT // ULUL

CLASS II PLATELETCLASS II PLATELET

*/.///2*/.///2$$ - # //.///2- # //.///2$$

&ITH &ITH LDHLDH 6//6// ULUL

SGOTSGOT

//

ULUL

CLASS II PLATELETCLASS II PLATELET

*/.///2*/.///2$$ - # */.///2- # */.///2$$

&ITH &ITH LDHLDH

6//6//

ULUL

SGOTSGOT // ULUL

CLASSIFICATION BASED ON PLATELET COUNTCLASSIFICATION BASED ON PLATELET COUNT

(MISSISIPPI):(MISSISIPPI):


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3ANA!E3EN. %F HELLP S2N/R%3E3ANA!E3EN. %F HELLP S2N/R%3E

MATERNAL STABILISATION IS THE MAYOR PRIORITYMATERNAL STABILISATION IS THE MAYOR PRIORITY

BEGIN &ITH A STANDART MANAGEMENT OF SEVEREBEGIN &ITH A STANDART MANAGEMENT OF SEVERE

PREECLAMPSIAPREECLAMPSIA

HELLP SYNDROME IS NOT AN INDICATION FOR CSHELLP SYNDROME IS NOT AN INDICATION FOR CS

3E/I1AL 3ANA!E3EN.3E/I1AL 3ANA!E3EN.


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3E/I1AL 3ANA!E3EN.3E/I1AL 3ANA!E3EN.

SAME AS SEVERE PREECLAMPSIASAME AS SEVERE PREECLAMPSIA

&HEN THROMBOCYTE COUNT IS # */./// 22&HEN THROMBOCYTE COUNT IS # */./// 22$$, / UNITS, / UNITS

OF THROMBOCYTE OR FRESH &HOLE BLOOD MUST BEOF THROMBOCYTE OR FRESH &HOLE BLOOD MUST BE

GIVENGIVEN

&HEN PATIENT IS COMATOUS, SHE MUST BE TAKEN TO&HEN PATIENT IS COMATOUS, SHE MUST BE TAKEN TO

THE ICUTHE ICU

&HEN THROMBOCYTE COUNTS IS # */.///22&HEN THROMBOCYTE COUNTS IS # */.///22$$

FIBRINOGEN LEVEL, PROTHROMBINE TIME, PARTIALFIBRINOGEN LEVEL, PROTHROMBINE TIME, PARTIAL

THROMBOPLASTIN TIME, D-DIMMER MUST BE CHECKEDTHROMBOPLASTIN TIME, D-DIMMER MUST BE CHECKED

TO FIND DICTO FIND DIC



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&HEN MOTHERS IS STABLE&HEN MOTHERS IS STABLE

TERMINATE THETERMINATE THE

PREGNANCY OR CONSERVATIVE MANAGEMENT.PREGNANCY OR CONSERVATIVE MANAGEMENT.

CONSERVATIVE MANAGEMENT CAN BE DONECONSERVATIVE MANAGEMENT CAN BE DONE

&HEN &HEN

THE BLOOD PRESSURE # 6// 2THE BLOOD PRESSURE # 6// 2

THE OLIGURIA RESPONSE TO FLUIDTHE OLIGURIA RESPONSE TO FLUID

REPLACEMENTREPLACEMENT

THERE IS NO EPIGASTRIC PAINTHERE IS NO EPIGASTRIC PAIN

THE GESTATIONAL AGE IS # $ &EEKSTHE GESTATIONAL AGE IS # $ &EEKS


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1%3PLI1A.I%N1%3PLI1A.I%N

THE COMPLICATIONS THAT CAN OCCUR INTHE COMPLICATIONS THAT CAN OCCUR IN

HELLP SYNDROME ARE NEUROLOGICHELLP SYNDROME ARE NEUROLOGICDISORDER, PULMONARY EDEMA, ABRUPTIODISORDER, PULMONARY EDEMA, ABRUPTIO

PLACENTA, DIC ANDPLACENTA, DIC AND

UGRUGR

1%N1L0SI%NS1%N1L0SI%NS


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1%1% HYPERTENSION, PROTEINURIA AND OTHERS SYMPTOMS*SIGN O&HYPERTENSION, PROTEINURIA AND OTHERS SYMPTOMS*SIGN O&

PREELAMPSIA ARE INDUED BY PREGNANYPREELAMPSIA ARE INDUED BY PREGNANY

2%2% BESIDE HYPERTENSION AND PROTEINURIA, OTHER SYNDROMA O&BESIDE HYPERTENSION AND PROTEINURIA, OTHER SYNDROMA O&

PREELAMPSIA ARE EPIGASTRI PAIN, HEADHE, +ISUAL DISTURBANE,PREELAMPSIA ARE EPIGASTRI PAIN, HEADHE, +ISUAL DISTURBANE,

OLIGURIA, ON+ULSION, AND RENAL &AILURE%OLIGURIA, ON+ULSION, AND RENAL &AILURE%

!%!% THERE ARE STILL ONTRO+ERSION IN LASSI&IASION, DIAGNOSTITHERE ARE STILL ONTRO+ERSION IN LASSI&IASION, DIAGNOSTI

AND MANAGEMENT O& PREGNANY INDUED HYPERTENSION%AND MANAGEMENT O& PREGNANY INDUED HYPERTENSION%

4%4% IN PATIENTS 'ITH MULTI ORGAN DYS&UNTION / &AILURE MULTIDISIPLININ PATIENTS 'ITH MULTI ORGAN DYS&UNTION / &AILURE MULTIDISIPLINMANAGEMENT IS NEEDED%MANAGEMENT IS NEEDED%

(%(% IGNORANE, PO+ERTY, LATE ADMITTANE TO HOSPITAL 'ILL INREASEIGNORANE, PO+ERTY, LATE ADMITTANE TO HOSPITAL 'ILL INREASE

&ERINATAL * MATERNAL, MORBIDITY AND MORTALITY&ERINATAL * MATERNAL, MORBIDITY AND MORTALITY

1%N1L0SI%NS :1%N1L0SI%NS :


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RE(ERENCES


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RE(ERENCES %

. B9:; PN., K42 ?., Preeclampsa! C"rre#$ Perspec$%es Ma#a'eme#$. T@; P9@;=4= P5


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6. R4; ?M, C9 A H5; O>9


47/47

. M99== EF, M9

k16 - hipertensi dalam kehamilan (rhr).ppt

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