pe & e
TRANSCRIPT
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PENGELOLAANPREEKLAMSIA - EKLAMSIA
Bag. Obstetri & Ginekologi RS Dr Kariadi/FK UNDIP
Semarang 2006
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PENYEBAB KEMATIAN IBU
Perdarahan Infeksi Preeklamsia - Eklamsia
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Konsep Sekarang : CUKUP SATU GEJALA SAJA :
HIPERTENSI
PREEKLAMSIA - EKLAMSIA
HIPERTENSI DALAM KEHAMILANKonsep Dulu :
HIPERTENSI DAN EDEMA ATAU PROTEINURIA
TOKSEMIA
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DEFINISI
Sekelompok penyulit yang timbul pada masa hamil, persalinan, nifas dan ditandai adanya:
HIPERTENSI EDEMA DAN ATAU PROTEINURIA
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KLINIK : MONO SYMPH. EPH
GESTOSIS POLY SYMPH. EPH GESTOSIS IMMINENT ECLAMPSIA ECLAMPSIA
PATOGENETIK : SUPERIMPOSED EPH GESTOSIS TRANSIENT EPH GESTOSIS UNCLASSFIED EPH GESTOSIS CONCOMITANT DISEASE OTHER CASES
KLASIFIKASI (ORG. GESTOSIS )
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ASPEK KLINIK
+ PRE EKLAMSIA RINGAN + PRE EKLAMSIA BERAT + EKLAMSIA
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PRE EKLAMSIA RINGAN :
IBU HAMIL > 20 MINGGU TENSI SISTOLIK > 140 mmHg TENSI DIASTOLIK > 90 mmHg KENAIKAN SISTOLIK > 30 mmHg KENAIKAN DIASTOLIK > 15 mmHg
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PRE EKLAMSIA BERAT :
PRE EKLAMSIA RINGAN & SALAH SATU GEJALA :
SISTOLIK > 160 mmHg DIASTOLIK > 110 mmHg PROTEINURIA > 5 g/24 jam OLIGURIA < 400 cc/24 jam NYERI EPIGATRIUM EDEMA PARU GG. PERTUMBUHAN JANIN INTRA UTERINA ‘’ HELLP SYNDROME ‘’
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DIAGNOSIS EKLAMSIA
Pre eklamsia ringan / berat Kejang - kejang Koma / kehilangan
kesadaran
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‘ IMPENDING EKLAMPSIA ‘
GEJALA OBYEKTIF : HIPER REFLEKSI EKSITASI MOTORIK GANG. KESADARAN SIANOSIS
GEJALA SUBYEKTIF : HEAD ACHE GANGGUAN VISUAL
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PENYULIT PADA EKLAMSIA
GANGGUAN SISTEM NAFAS HIPERVENTILASI EDEMA PARU
GANGGUAN SISTEM KARDIO-VASKULER
AFTER LOAD (HIPERTENSI+VASOSPASME)
KONTRAKTILITAS(PAYAH- JANTUNG) PRE LOAD (HIPOVOLEMIA)
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PENYULIT PADA EKLAMSIA
GANGGUAN SSP EDEMA OTAK HIPEREMIA TROMBOSIS PERDARAHAN OTAK ANEMIA
GANGGUAN SIST. UROGENITAL GFR TURUN RENAL KORTIKAL TUBULAR
NEKROSIS
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ETIOLOGI
TROFOBLAST IMUNOLOGIK PREDISPOSISI FAMILIAL FAKTOR HORMONAL FAKTOR GIZI CHESLEY (1978) DEF. AS. ARACHIDONAT
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PERANAN PROSTACYCLIN DAN ANGIOTENSIN II
ARACHIDONIC ACID
CYCLIC ENDOPEROKSIDASE
PROSTAGLANDIN THROMBOXANE
PROSTAGLANDIN E2
Pada hamil NORMAL :
KESEIMBANGAN PROSTAGLANDIN DAN THROMBOXANE
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PATOGENESIS
HIPOVOLEMIA TROFOBLAST SEL ENDOTEL PENURUNAN RATIO PROSTACYCLIN - TROMBOXANE DEFISIENSI ASAM ARACHIDONAT
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AKIBAT VASOKONSINTRIK DAN HIPOVOLEMIA
VASOKONSTRIKSI
PLASMA VOL. > HEMOKONSENTRASI VIKS. DARAH
KONS. O2 PERFUSI JAR. ALIRAN DRH. REG.
OTAKJANTUNG
GINJALUTERUS
ENDOT. ARTERIOLE
KERUSAKAN ENDOT
RAWAN PERDARAHAN PLASENTA TROMBOXANE
SYOK IUGR/IUFD VASOKONSINTRIK
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DETEKSI DINIADANYA KEPEKAAN VASKULER :
Cold Pressure Test (Brown, 1933)
Flicker Fusion Test (Ivy, 1960)
Isometric Exercise Test (Degani, 1985)
Roll Over Test (ROT) (Gant, 1974)
Infuse Cathecolamine (Zuspan, 1964)
Infuse Vasopressin (Lambillon, 1937)
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DETEKSI DINI
adanya kepekaan vaskuler :
• Roll Over Test (ROT)
+
• MAP > 85 mmhg
PE/E
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PENGOBATAN HDK
KLINIK CEGAH DAN ATASI KEJANG MENURUNKAN TENSI CEGAH PENYULIT SIAPKAN IBU OPTIMAL
MEDISINALIS
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PENGOBATAN HDK
PATOGENETIK RATIO PROSTASIKLIN/
TROMBOXANE HIPOVOL. NORMO/HIPERVOL. HILANGKAN VASOKONSTRIKSI
MEDISINALIS
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PENGOBATAN HDK
PRE EKLAMSIA RINGAN PRE EKLAMSIA BERAT EKLAMSIA
OBSTETRIK
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TERAPI PE RINGAN
RAWAT JALAN : ISTIRAHAT DIIT CUKUP PROTEIN,
RENDAH KH, LEMAK
DIAZEPAM 3 X 2 mg / hr VITAMIN E ASPIRIN
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TERAPI PE RINGAN
RAWAT TINGGAL : 2 MINGGU TERAPI TAK RESPON ADA GEJALA PE BERAT
OBSTETRIK : PRETERM & NORMOTENSI :
TUNGGU ATERM ATERM : TUNGGU ONSET /
40 MINGGU
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TERAPI PE BERAT RAWAT RUANG ISOLASI Infus RL 2000 cc / 24 jam Pasang DC Anti Kejang :
MgSO4 40% 10 gram IM; Syarat : Refleks tendo lutut positif Tersedia Glukonas kalsikus /
Kalsium Chlorida Respirasi rate > 16 kali / menit Diuresis > 100 cc / 4 jam
Diazepam Anti Hipertensi: tensi > 180 / 110
mmHg
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ANTI KONVULSAN
MgSO4
• 4 gr MgSO4 20% intra vena• 10 gr MgSO4 40% intra muskuler• Lanjutkan tiap 4 - 6 jam
DIAZEPAM 10 mg Intravena 10 mg drip dalam D-5% Maksimum 100 mg / hari
muscle relaxant (ICU)
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TERAPI EKLAMSIA
Sama dengan PE BERAT Kejang pasang sudip lidah,
kepala miring ke kiri Anti Kejang :
MgSO4 20% 4 gram IV (lebih 3 menit)
MgSO4 40% 10 gram IM Anti Hipertensi : bila tensi
mencapai 180 / 110 mmHg
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TERMINASI ?
EKLAMSIA : Terminasi kehamilan TANPA
memandang umur kehamilan
Kapan : 4 - 8 jam sesudah : sadar kejang terakhir pemberian MgSO4 terakhir
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TERMINASI ?
PRE EKLAMSIA BERAT : 2 X 24 jam dengan terapi adequat, tidak respon dalam perawatan 24 jam pertama tensi naik Ablatio Retinae Hamil > 37 minggu TBJ > 2200 gram
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TERMINASI ?
PRE EKLAMSIA RINGAN : Hamil 40 minggu belum inpartu Berkembang menjadi PE BERAT
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0 1 2 3
Edema stl istirahat baring
- tibia Umum -
Proteinuria < 0.5 + ++ +++
Semi Kuantitatif Esbach
0.5 - 2 2-5 > 5
Tensi Sistolik < 140 140-160 160-180 >180
Tensi Diastolik < 90 90-100 100-110 > 110
INDEKS GESTOSIS
Gejala Impending Eklamsia EI Ya/Tidak
Gejala Convulsive Eklamsia E Ya/Tidak
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