pemicu 2 blok reproduksi

8/18/2019 Pemicu 2 Blok Reproduksi

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PEMICU 2 BLOK

REPRODUKSI

ALMIRA NABILA VALMAI

405130193


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KELAINAN KEHAMILANPADA IBU

LO 1


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Anemia dalam Keamilan

KeamilanKe!"#"anO$%i&en '

P()d"$%ie(i#()*)ei#in '

E%#()&en+*()&e%#e()n '

V)l *la%ma '

Ini%ia%i ,al"( RAA

-"mla %el da(ame(a '

-"mla %el da(a me(a ' #ida$%e!andin& den&an ' .)l *la%ma

/em)del"%i dan *en"("nan

$)n%en#(a%i /!/ema#)$(i#


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Epidemiologi

• (e$"en%i i!" amilden&an anemia diInd)ne%ia (ela#i #in&&iai#" 3567

• Men"("# 8/O 406$ema#ian i!" dine&a(a !e($em!an&!e($ai#an den&an

anemia dalam$eamilan

Etiologi

• Pene!a! –

De:%ien%i ;a#


5/120

• Nilai !a#a% anemia*ada *e(em*"an – @ida$ amil /! 120

&dl /# 36

– /amil #(ime%#e( I /!110 &dl /# 336

– /amil #(ime%#e( II /!105&dl /# 326

– /amil #(ime%#e( III /!

110 &dl /# 336

• De(a,a# anemia

17 /! 11 &(6 @ida$anemia27 /! 9


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Klasifkasi

• Anemia De:%ien%i Be%i –

#e(,adi a$i!a# $e$"(an&an ;a#!e%i dalam da(a

• Anemia Me&al)!la%#i$ – di%e!a!$an )le $a(ena

$e$"(an&an a%am )li$

• Anemia /i*)*la%#i$ –

di%e!a!$an )le i*)"n&%i%"m%"m #"lan& mem!en#"$ %elda(a me(a !a("

• Anemia /em)li#i$ – di%e!a!$an *en&an="(an a#a"

*eme=aan %el da(a me(aan& le!i =e*a# da(i

*em!"a#anna7 He,ala "#amaadala anemia den&an $elainan<$elainan &am!a(an da(a$elelaan $elemaan %e(#a&e,ala $)m*li$a%i !ila #e(,adi$elainan *ada )(&an


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@(i%eme%#e( I

A$i!a# Anemia


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Dia&n)%a

• Peme(i$%aan $ada( /!

• Peme(i$%aan %el da(a #e*i


9/120

Anemia De:%ien%i Be%i *adaKeamilan

• @e(,adi $a(ena – Pen&alian !e%i ma#e(nal $e ,anin "n#"$ e(i#()*)e%i%

– Keilan&an da(a %aa# *e(%alinan

– La$#a%i

• He,ala – P"%in&

– Pal*i#a%i

– Lema lela

– le%"

• Pen=e&aan %"*lemen#a%i ;a# !e%i dan a%am )la#%e#ia* a(i *ada i!" amil7 – >a# !e%i 0 m& %elama !"lan "n#"$ memen"i $e!"#"an

:%i)l)&i$ %elama $eamilan ?8/O


10/120

Anemia De:%ien%i )la# *adaKeamilan

• Ke!"#"an )la# ' $a(ena – #(an%e( )la# da(i i!" $e ,anin %ein&&a

$e!"#"an )la# ' 5


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Anemia De:%ien%i )la# *adaKeamilan

• He,ala – P"%in& lema lela le%" *al*i#a%i

– Hl)%%i#i%

– K"li# an& $a%a(

•

Peme(i$%aan la! – SAD@ anemia ma$()%i#i$ n)(m)$()m *e(!andin&an in#i<

%i#)*la%ma an& a!n)(mal

– MC/ + MC/C n)(mal

– Kada( )la# %e("m G3 n&ml

• @a#a la$%ana – Pem!e(ian )la# %e=a(a )(al 1


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In!eksi "i#$s

Pa#%o%i#$s &B1'(• Mani!estasi klinik )

– Rin&an

– deJa%a 20


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$ $Hepatitis B(

•Ine$%i a$"# *ada

$eamilan e*a#i#i% "lminanm)(#ali#a% '*ada i!" dan !ai7

•a$#)( *(edi%*)%i%i

*en"la(an .e(#i$al17 @i#e( DNA


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In!eksi Mala#ia

• Pada i-$ – Anemia

– mala(ia %e(e!(al

– edema *a("?#(ime%#e( II + III

– &a&al &in,al

– $ema#ian

• Pada janin – A!)(#"%

– *e(%alinan*(ema#"(

– !e(a# !adan lai((enda

– In%":%ien%i *la%en#a

– @(an%mi%i*la%m)di"m

– $ema#ian ,anin7

Dampak


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Klini% @))*la%m)%i%


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/ind#om 0$-ella• Manie%#a%i Klini$ $eamilan

– mal!o#masi jant$ng %e*e(#i D"=#"% A(#e(i)%"%Pa#en =a=a# %e*#"m in#e(.en#(i$"la(e a#a"%#en)%i% *"lm)nali%

–lesi mata %e*e(#i $)(nea men"(am $a#a(a$$)(i) (e#ini#i% dan mi$()#almia

– mik#ose!ali #eta#dasi mental dan ket$lian

– Be!e(a*a !ai di#em"$an mende(i#a

im$nnodefsiensi ,$mo#al dan2 ata$ sel$la#


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Manie%#a%i Klini$ 3M"

In!eksi 3M" Kongenital

• Pe#e$iae e*a#)%*len)me&ali dan i$#e("%

• Mi$()%eali den&an a#a" #an*a $al%i:$a%i=e(e!("m (e#a(da%i *e(#"m!"an in#(a"#e("% dan*(ema#"(i#a%7

• Ke!ana$an ine$%i CMV K)n&eni#al #a$ ,ela%%e=a(a $lini$ %aa# lai(7

• An#a(a 5


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In!eksi 3M" Pe#inatal

• Ne)na#"% !i%a menda*a# CMV *ada Ja$#" *e(%alinan)le leJa# melal"i ,alan lai( #e(ine$%i a#a" )le$)n#a$ *a%=alai( den&an %"%" i!" a#a" %e$(e%i lain7

• 40


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Dia!e#e% Meli#"%He%#a%i)nalPatofsiologi

Keamilan

Pla%en#a mela$"$an %e$(e%i )(m)n dia!e#)&eni$ •

/)(m)n *e(#"m!"an ?&()J# )(m)n• C)(#i=)#()*in (elea%in& )(m)n

• Pla=en#al la=#)&en• P()&e%#e()n

Re%i%#en%i In%"lin

-i$a "n&%i *an$(ea% #ida$ ="$"* "n#"$ men&a#a%i$eadaan ini

Dia!e#e% Meli#"% He%#a%i)nal


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Dia!e#e% Meli#"%He%#a%i)nalDiagnosis• Peme#iksaan kada# g$la da#a,

se4akt$ – Kada( &l"$)%a 2 ,am *a%=a !e!an &l"$)%a 5 &

Gl$kosa da#a, K#ite#ia

200 m&dl Dia!e#e% meli#"%

140


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Peme#iksaan 0ed$ksi U#ine

• Me("*a$an -agian da#i peme#iksaan$#ine #$tin .ang selal$ dilak$kan diklinik5

• /a%il an& ? men"n,"$$an adana

&l"$)%"(ia7• Di&"na$an *ada *eme(i$%aan *e(#ama

%e$ali "n#"$ #e% %$(inin& -$kan $nt$kmenegakkan diagnosis

• Nilai ? %am*ai ? – Red"$%i ? ma%i m"n&$in )le %e!a! lain

%e*e(#i (enal &l"$)%"(ia )!a#


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Komplikasi DMG

• Ma#e(nal – Ine$%i %al"(an $emi – /id(amni)n – /i*e(#en%i $()ni$ –

P(ee$lam*%ia – Kema#ian i!"

• e#al – A!)(#"% %*)n#an – Kelainan $)n&eni#al – In%":%ien%i *la%en#a – Ma$()%)mia – Kema#ian in#(a"#e(in

• Ne)na#al – P(ema#"(i#a%

– Kema#ian in#(a"#e(in

– Kema#ian ne)na#al

– @(a"ma lai( – /i*)&li$emia

– /i*)ma&ne%emia

– /i*)$al%emia

–/i*e(!ili("!inemia

– Sind()m &aJa# na*a%

– P)li%i#emia


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Dia!e#e% Meli#"%He%#a%i)nal15Diet75e#api ins$lin:5Penatalaksanaan O-stet#i

– Pan#a" i!" dan ,anin den&an • Men&"$"( #in&&i "nd"% "#e(i• Menden&a($an !"ni ,an#"n& ,anin• Mema$ai USH dan K@H

– Nilai ,anin %e=a(a menel"(" den&an

%$)( "n&%i Dinami$ -anin Pla%en#a?D-P• Dila$"$an den&an menilai

– USH – NS@ – USH D)**le(


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Penatalaksanaan O-stet#ik Ke,amilan

Dengan DM

DM


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Keamilan E$#)*i$


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Keamilan E$#)*i$


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Keamilan E$#)*i$


28/120

Keamilan E$#)*i$


29/120

Keamilan E$#)*i$


30/120

Keamilan E$#)*i$


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32/120


33/120

Keamilan E$#)*i$


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C"ld)=en#e%i%


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Sal*in&)%#)m


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37/120

Keamilan @"!a


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/IPEREMIS HRAVIDARUM

• K)ndi%i m"n#a


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E*idemi)l)&i

• @e(da*a# *(e%ile$%i e#ni% dan$e#"("nan

• An&$a (aJa# ina* !e($i%a( an#a(a05


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Pa#)&ene%i% danPa#):%i)l)&i

• Penin&$a#an =e*a# dan #in&&i CH%elain i#" e%#()&en *()&e%#e()n*()la$#in #i()$%in )(m)n dan

ad(en)$)(#i$al• Pen"("nan /CO dan *en"("nan

m)#ili#a% )#)# %al"(an =e(na

menim!"l$an &e,ala m"al• K)ndi%i *%i$)l)&i%


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• M"al m"#a deid(a%i

• Cadan&an ene(&i K/ a!i% )$%ida%i lema$ $e#)%i%

• M"al m"n#a ()!e$an mallory

weis HHA *ne"m)#)(a$%*ne"m)media%#in"m


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a$#)( (e%i$)

• RiJaa# $eamilan den&ani*e(eme%i% &(a.ida("m

• BB !e(le!i

• He%#a%i m"l#i*el

• Pena$i# #())!la%#i$

•

n"li*a(a


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Manie%#a%i $lini%

• M"al dan m"n#a

• Han&"an a$#i.i#a%

• Pen"("nan BB

• /i*e(%ali.a%i

• @anda


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Dia&n)%i%

• Anamne%i% @ana$an $el"an!e(da%a($an manie%#%i $lini%

• Peme(i$%aan :%i% #anda .i#al

deid(a%i #anda $eamilan

• Peme(i$%aan *en"n,an& da(alen&$a* ele$#()li# "(inali%i%

?$e#)n"(ia USH


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@a#ala$%ana

• N)n medi$amen#)%a – I%#i(%aa##i(a !a(in&

– Pem!e(ian ma$an dalam ,"mla %edi$i#

nam"n (e$"en%i %e(in& – /inda(i ma$anan a%am *eda% %e(#a

!e(lema$

–

=ai(an ade$"a#


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• Medi$amen#)%a – Reid(a%i =ai(an $(i%#al)id ?$)(e$%i

deid(a%i $e#)nemia $elainanele$#()li#&an&&"an a%am !a%a

– An#i


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P()&n)%i%

• @e(a*i an#i


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Kla%i:$a%i

49

/IPER@ENSI KRONIK#im!"l %e!el"m "m"( $eamilan 20m& a#a" *e(#ama $ali

didia&n)%i% %#l "m"( $eamilan 20m& dan i*e(#en%imene#a* %am*ai 12 min&&" *a%=a*e(%alinan

PRE


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a$#)( Re%i$)

P(imi&(a.ida *(imi*a#e(ni#a%

/i*e(*la%en#)%i% e M)la ida#id)%a

Keamilan m"l#i*el

DM/id()*% e#ali%

Bai !e%a(

Um"( an& e$%#(im

RiJaa# *(ee$lam*%iae$lam*%i

Pena$i#2&in,al dan i*e(#en%i an& %"da ada%e!el"m amil

O!e%i#a%

50


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Pa#):%i)l)&i /i*e(#en%i

51

17 @e)(i Kelainan Va%$"la(i%a%i Pla%en#a

27 @e)(i I%$emia Pla%en#a Radi$alBe!a% Dan Di%"n&%i End)#el

37 @e)(i In#)le(an%i Im"n)l)&i$ an#a(aI!" dan Bai

47 @e)(i Ada*#a%i Ka(di).a%$"la(Hene#i$

57 @e)(i De:%ien%i Hi;i

7 @e)(i Inama%i


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Pa#):%i)l)&i /i*e(#en%i

• @e)(i $elainan .a%$"la( *la%en#a

– In.a%i #())!la% $e dalam la*i%an )#)# dila#a%i a7%*i(ali%7 *en"("nan #e$

da(a

*enin&$a#an ali(an da(a *ada"()*la%en#a da(a ="$"* !ana$ (em)delin& a(#e(i %*i(ali%

– Pada i*e(#en%i #ida$ #e(,adi in.a%i

#())!la% %ein&&a $e&a&alan(em)delin& i*)$%ia dan i%$emi*la%en#a

52


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@e)(i i%$emia *la%en#a (adi$al !e!a% di%"n&%iend)#elI%$emi dan i*)$%ia men&a%il$an )$%idan id()$%il

an& %an&a# #)$%i%7me("%a$ mem!(an %el an&

men&and"n& !ana$ a%am lema$ #a$ ,en" men,adi*e()$%ida lema$7me("%a$ n"$le"% *()#ein %elend)#el

P()d"$%i )$%idan an& !e(%ia# #)$%i% da*a# diim!an&iden&an an#i)$%i dan Pe()$%ida lema$ %e!a&ai )$%idan

*ada i*e(#en%i7An#i)$%idan %*# .i# E *ada i*e(#en%i $eamilan men"("n

d)mina%i $ada( )$%idan *e()$%ida lema$ an& #in&&i me("%a$ %el end)#el

53


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– Di%"n&%i end)#el• Sel end)#el #e(*a*a( *e()$%ida lema$ $e("%a$an

%el end)#el &an&&"an "n&%i end)#el ?di%"n&%iend)#el7 Pada $e("%a$an ini a$an #e(,adi

–Han&&"an me#a!)li%me *()%#a&landin

*()%#a&landin men"("n

– A&(e&a%i %el #()m!)%i# *ada dae(a end)#elan& men&alami $e("%a$an

– Pe("!aan $a% *ada &l)me("la( end)#eli)%i%

– Penin&$a#an *e(mea!ili#a% $a*ile(

– Penin&$a#an a$#)( $)a&"la%i

54


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• @e)(i in#)le(an%i im"n)l)&i$ an#a(a i!" dan ,anin

– P(imi&(a.ida memili$i (e%i$) le!i !e%a(

#e(,adi i*e(#en%i di!andin& m"l#i&(a.ida – I!" m"l#i*a(a an& $em"dian meni$a

la&i mem*"nai (e%i$) le!i !e%a(di!andin&$an den&an %"ami

%e!el"mna – Se$% )(al mem*"nai (e%i$) le!i

(enda #e(,adina i*e(#en%i dalam

$eamilan 55


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• @e)(i ada*#a%i $a(di).a%$"la( – Keilan&an daa (e(a$#e( #e(ada*

!aan

*enin&$a#an $e*e$aan #e(ada* !aan<!aan .a%)*(e%)( *em!"l" da(am"da .a%)$)n%#(i$%i i*e(#en%i

• @e)(i &ene#i$ – Hen)#i* i!" le!i menen#"$an

#e(,adina i*e(#en%i dalam $eamilan%e=a(a amilial ,i$a di!andin&$an den&an

&en)#i* ,anin 5


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• @e)(i de:%ien%i &i;i – Di!e(i$an !ana$ mina$ i$an dan

$al%i"m "n#"$ *en=e&aan i*e(#en%i

• @e)(i %#im"l"% inama%i – Le*a%na de!(i% #())!la% dalam

%i($"la%i da(a me("*a$an (an&%an&an

"#ama #e(,adina inama%i – Adana de!(i% #())!la% !e(le!ian

men&a$i!a#$an a$#i.i#a% le"$)%i# an&#in&&i *ada %i($"la%i i!"

5


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Pe#$-a,an /istem O#gan pada P#eeklampsia

Volume plasma

/i*).)lemia + .a%)$)n%#(i$%i i*e(#en%i

Hipertensi

Pe' (ea$#i.i#a% .a%$"la( *ada m& $e


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Elektroli t

• Ele$#()li# men"("n *d Ja$#" amil n)(mal7• Pd *(ee$lam*%ia $ada( ele$#()li# #)#al Q amil

n)mal $e="ali !ila di!e(i di"(e#i$"m !ana$(e%#(i$%i $)n%"m%i &a(am a#a" *em!e(ian=ai(an )$%i#)%in ?di"(e#i$

• P(ee$lam*%ia !e(a# & men&alami i*)$%ia d*#menim!"l$an &&& $e%eim!an&an a%am !a%a7

Tekananosmotik

dankoloid

Men"("n $a(ena $e!)=)(an *()#ein +*enin&$a#an *e(mea!ili#a% .a%$"le(

Koagulasi

- @()m!)%i#)*enia-' DP- an#i#()m!in III-' :!()ne$#in

59



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Viskositasdarah

Vi%$)%i#a% da(a ' (e%i%#en%i *e(ie(' ali(anda(a $e )(&an

Hematokr it /i*).)lemia

/ema#)$(i# '?men&&am!a($an !e(a#na *(ee$lam*%ia

Edema /i*)al!"minemia $e("%a$an end)#el $a*ile( edema06 *d $eamilan d& i*e(#en%i

F06

*d $eamilan d& i*e(#en%i + *()#ein"(iaPa#)l)&i% ,i$a -Edema *d m"$a + #an&an Edema &ene(ali%a#a-Di%e(#ai $enai$an BB & =e*a#

Paru Edema *a(" e7=7 *aa ,an#"n& $e("%a$an

end)#el $a*ile( *a(" + men"("nna di"(e%i%Hematolo

gik-Penin&$a#an ema#)$(i# + .i%$)%i#a% da(a- @()m!)%i#)*enia-He,ala em)li%i% mi$()an&i)*a#i$

0

Pe#$-a,an /istem O#gan pada


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Pe#$-a,an /istem O#gan padaP#eeklampsia

Hepar Va%)%*a%me + i%$emia ne$()%i% %el e*a(Pe(da(aan %"!$a*%"la( ema#)ma

Neurologik -/i*e(*e("%i )#a$ ne(i $e*ala-S*a%me + edema (e#ina &an&&"an .i%"%-/i*e((ee$%i-Ke,an& ? e7=7 edema .a%)%*a%me dan

i%$emia %e(e!(i-Pe(da(aan in#(a$(anial

Kardiovask ular

' =a(dia= a#e(l)ad e7=7 i*e(#en%i =a(dia= *(el)ad e7=7 i*).)lemia

Janin ↑morbiditasdanmortalitas

-In#(a"#e(in H()J# Re%#(i=#i)n +Oli&)id(amni)n-P(ema#"(i#a%-S)l"%i) *la%en#a

1

P P $l i


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Pen=e&aan P(ee$lam*%ia <N)nmedi=al

• @i(a !a(in&

• Die# %"*lemen & men&and"n& – Mina$ i$an & $aa d& a%am lema$ #d$

,en" ?)me&a


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Pen=e&aan P(ee$lam*%ia < Medi$al

• Kal%i"m 1500


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Se.e(e /)*e(#en%i)n in P(e&nan=

Hydralazine Short-acting nifedipine labetalol

Choic

eofdrug

1st choice for severe

pregnancy hypertension

required by midwives or

nurses in the absence ofa doctor

used extensively

in pregnancy

has a favorableside

effect

Sideeffect

Headache Nausea

Vomiting

→ mimic symptoms of

deteriorating preeclampsia

Maternal hypotension

: associated with an excess of c!sec

placental abruptions

low "pgar scores #$%& at'min

if coronary arterydisease

or diabetes #(&

→associated with excess

cardiovascular morbidityand

mortality transient neuromuscular

wea)ness #* case reports&

: nifedipine(magnesiumsulfate

ris) of neonatal bradicardia #+&

In#e(na#i)nal H"ideline%


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Se.e(e /)*e(#en%i)n in P(e&nan=M

Hydralazine Short-acting nifedipine Labetalol

Site of

action

Vasodilators

Vascular smooth muscle

,,-

#,alcium channelantagonists&

Vascular smooth m.

"ntiadrenergic

agent

/ 0 receptors

Indicat-ion

moderate2severe H-3

#oral&

malignant hypertension #4V5 4M&

renal disease with

hypertension

Mild2moderate H-3 Mild2moderateH-3

Onset 162*6min

#pea) : 162*6min&

Nicardipine : '216min

#pea) : *6276min&

'min

#pea) : *6286min&

Duration 721*h 127h 829h

Dosage oral :162%'mg qid

4V or 4M:162'6mg every9h

#tolerance may develop&

oral : 8626mg qd oral:1662966mg bid

4V : *mg bid

- Harrison’s15th edition

In#e(na#i)nal H"ideline%Se.e(e /)*e(#en%i)n in P(e&nan=M Hydralazine Short-acting nifedipine Labetalol


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Se.e(e /)*e(#en%i)n in P(e&nan=My z g f p Labetalol

Contraindication /cautions

;upus erythematousus

severe coronary aretery disease

Heart failure5 *nd or 8rd degree

heart bloc)

sideeffects

Headache

ash

?luid retension

tachycardia

flushing

gastrointestinal disturbance

hyper)alemia

edema headache

=i@@iness5 depression

bronchospasm

nausea5 vomiting5

darrhea ! constipation

heart failure5 fatigue >aynaudAs phenomenon

hallucinations

hypertriglyceridemia

hypercholesterolemia

psoriasis

sudden withdrawal may precipitate angina

myocardial inBury in

patients with heart

disease.

- Harrison’s15th edition


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P0EEKLAMP/IA

•/i*e(#en%i an& #im!"l 20 min&&" $eamilan dan

*()#ein"(ia

•Di!a&i men,adi *(ee$lam*%ia (in&an dan *(ee$lam*%ia!e(a#

•U("#an &e,ala *ada *(ee$lam%ia edema i*e(#en%i dan*()#ein"(ia7

•Bila &e,ala


68/120

F


69/120

P0EEKLAMP/IA 0INGAN

De:ni%i %"a#" %ind()ma %*e%i:$ den&an men"("nna

*e("%i )(&an an& !e(a$i!a# #e(,adina .a%)%*a%me

*em!"l" da(a dan a$#i.a%i end)#el

9


70/120

Dia&n)%i%

• Di#e&a$$an !e(da%a( #im!"lnai*e(#en%i di%e(#ai *()#ein"(iadanedema %e#ela $eamilan 20

min&&" – /i*e(#en%i T 14090 mm/&

– P()#ein"(ia T 300 m&24 ,am a#a" T 1

di*%#i$ – Edema edema l)$al #ida$ dima%"$$an

dalam $(i#e(ia *(ee$lam*%ia $e="aliedema *ada len&an m"$a dan *e("#

edema &ene(ali%a#a 0


71/120

@","an Um"m Pe(aJa#an

1

• Men=e&a *e(da(aan in#(a$(anial +$e,an&

• Men=e&a &an&&"an "n&%i )(&an

.i#al• Melai($an !ai %ea#


72/120

0a4at jalan 0a4at Inap

• Bana$ i%#i(aa#

• @id"( mi(in& G #e$anan*d V7=a.a Ine(i)(

• C"$"* *()#ein (endaK/ lema$ + &a(am?2&a(i %e="$"*na

• @ida$ di!e(i$an )!a#2an

di"(e#i$ a#ii*e(#en%i dan%eda#i

• Peme(i$%aan ("#in /! /#aal a#i + &in,al "(inali%a

• Bila *e(!ai$an @D +*()#ein"(ia %elama2m& dan adana 1#anda *(ee$lam*%ia!e(a#

• Anamne%i%*eme(i$%aan :%i$ danla!)(a#)(i"m

• Peme(i$%aan ,anin *e(#"m!"an dan

,"mla =ai(an amni)n

2

Pe(aJa#an O!%#e#(i$ Si$a* #*


73/120

Pe(aJa#an O!%#e#(i$ Si$a* #*Keamilan

3

Keamilan *(e#e(m 22


74/120

P0EEKLAMP/IA BE0A

De:ni%i *(ee$lam*%ia den&an @D %i%#)li$

T 10 mm/& dan dia%#)li$ T 110 mm/&

di%e(#ai *()#ein"(ia 5&24 ,am

4


75/120

Dia&n)%i%

• @D %i%#)li$ T10 mm/& + dia%#)li$ T110mm/&7 @D #d$ #"("n me%$i*"n i!" %ddi(aJa# di RS + %d men,alani #i(a !a(in&7

•

P()#ein"(ia 5&24 ,am a#a" 4 dlm*eme(i$%aan $"ali#a#i7

• Oli&)"(ia *()d"$%i "(in G 500 ==24 ,am7

• Kenai$an $ada( $(ea#inin *la%ma

• H&& .i%"% + %e(e!(al *en"("nan$e%ada(an ne(i $e*ala %$)ma#a +*andan&an $a!"(7

5


76/120

Dia&n)%i%

• Ne(i e*i&a%#(i"m a#a" ne(i *d $"ad(an $anana#a% a!d)men7

• Edema *a("2 + %ian)%i%

• /em)li%i% mi$(an&i)*a#i

• @()m!)%i#)*enia !e(a# G 1007000 %elmm3 a#a"*en"("nan #()m!)%i# d& =e*a#7

• H&& e*a( ?$e("%a$an e*a#)%el"le(*enin&$a#an $ada( alanin + a%*a(#a#e

amin)#(an%e(a%e• Pe(#"m!"an ,anin in#(a"#e(ine & #e(am!a#7

• Sind()m /ELLP

Pem!a&ian P(ee$lam*%ia


77/120

Pem!a&ian P(ee$lam*%iaBe(a#• P(ee$lam*%ia !e(a# #an*a impending

eclampsia

• P(ee$lam*%ia !e(a# den&an

impending eclampsia ?*(ee$lam*%ia!e(a# di%e(#ai &e,ala2 %"!,e$#i ne(i$e*ala e!a# &&& .i%"% m"n#a2

ne(i e*i&a%#(i"m + $enai$an *()&(e%i @D

Pe(aJa#an + Pen&)!a#an


78/120

Pe(aJa#an + Pen&)!a#anP(e$lam%ia Be(a#

F

• Pen=e&aan $e,an&

• Pen&)!a#an /@

• Pen&el)laan =ai(an

• Pelaanan %"*)(#i #* *en"li# )(&anan& #e(li!a#

• Saa# an& #e*a# "n#"$ *e(%alinan


79/120

EKLAMP/IA

De:ni%i *(ee$lam*%ia an& di%e(#aiden&an $e,an&


80/120

Ham!a(an Klini$

Ne(i $e*ala e!a# *ada !a&ian de*an a#a" !ela$an&$e*ala dan *enin&$a#an #e$anan da(a an& a!n)(mal

Han&&"an *en&lia#an melia# $ila#an


81/120

Dia&n)%i% Bandin&

• Penda(aan )#a$

• /i*e(#en%i

• Le%i )#a$

• Kelainan me#a!)li$

• Menin&i#i%

•

E*ile*%i% ia#()&eni$

F1

P # l $


82/120

Pena#ala$%anaan

• Ai(Ja B(ea#in& Ci(="la#i)n

• Men&a#a%i dan men&)!a#i $e,an& – Ma&ne%i"m %"la# #(i)*en#al dia;e*am

• Pe(aJa#an *ada Ja$#" $e,an& – Di(aJa# an& ="$"* #e(an& di!a(in&$an

di #em*a# #id"( an& le!a( dan (ail

#em*a# #id"( di*a%an& $"a# ma%"$$an%"da* lida $e*ala di(anda$an dandae(a )()a(in& dii%a* !ila *ende(i#a%ele%ai $e,an& %e&e(a !e(i )$%i&en

F2

P # l $


83/120

Pena#ala$%anaan

• Pe(aJa#an $)ma – Di"%aa$an ,alan na*a% a&a( #e#a*

#e(!"$a

– Sem"a !enda an& ada di dalam ()n&&am"l"# dan #en&&)(a$an !ai$ !e("*alendi( ma"*"n %i%a ma$anan a("%dii%a* %e=a(a in#e(mi#en

– Mela$"$an *en=e&aan de$"!i#"%

– Pem!e(ian ma$anan da*a# melal"i NH@

F3

P # l $


84/120

Pena#ala$%anaan

• Pe(aJa#an edema *a(" – Di(aJa# di ICU $a(ena mem!"#"$an

anima%i den&an (e%*i(a#)(

• Pen&)!a#an )!%#e#(i$ – Sem"a $eamilan den&an e$lam*%ia

a("% dia$i(i

–

Pe(%alinan dia$i(i !ila %"da men=a*ai%#a!ili%a%i em)dinami$a danme#a!)li%me i!"

F4

P i


85/120

P()&n)%i%

• Bila #ida$ #elam!a# dalam *en&)!a#an ma$a&e,ala *e(!ai$an a$an #am*a$ ,ela% %e#ela$eamilan dia$i(i

• Di"(e%i% a$an #e(,adi 12 ,am %e#ela *e(%alinan

• @e$anan da(a $em!ali n)(mal dalam !e!e(a*a ,am $em"dian

• E$lam*%ia #ida$ mem*en&a("i $eamilan!e(i$"#na $e="ali *ada i!" an& %"damem*"nai i*e(#en%i $()ni$

• P()&n)%i% ,anin !"("$

F5


86/120

M)la /ida#id)%a

S"a#" ma%%a a#a"*e(#"m!"an di dalam (aim

an& #e(,adi *ada aJal$eamilan

PENWEBAB


87/120

PENWEBAB

• Be(a%al da(i plasenta dana#a" ,a(in&an ,anin ana m"n&$in #e(,adi *ada aJal $eamilan

• Ma%%a !ia%ana #e(di(i da(i !aan

$elainan *ada %el #el"( (aim dana#a" $e$"(an&an&i;i7

•

Re%i$) an& le!i #in&&i di#em"$an *ada Jani#aan& !e("%ia di !aJa 20 #a"n a#a" dia#a% 40#a"n7

$# i$


88/120

a$#)( (e%i$)

• S#a#"% %)%ial


89/120

HE-ALA

• Pe(da(aan da(i .a&ina *ada Jani#a amil ?#(ime%#e( I• M"al dan m"n#a !e(a#

• Pem!e%a(an *e("# mele!ii "%ia $eamilan

• He,ala


90/120

DIAHNOSA

• Pada *eme(i$%aan *an&&"l a$andi#em"$an #anda


91/120

Peme(i$%aan Pen"n,an&

• Se("m /CH "n#"$ mema%#i$an$eamilan

• /CH %e(ial ?di"lan& *ada in#e(.al

Ja$#" #e(#en#"• USH *an&&"l

• R)n#&en dada

• C@ %=anMRI *e("#7

PENHOBA@AN


92/120

PENHOBA@AN

• M)la a("% di!"an& %el"("na !ia%ana ,i$a #ida$#e(,adi a!)(%i %*)n#an dan dia&n)%i%na %"da*a%#i dila$"$an aborsi terapeutik melal"i *()%ed"(dilatasi & kuretase7

•Pen&"$"(an $ada( /CH "n#"$ men&e#a"i a*a$a%el"(" m)la #ela #e(!"an&7 -i$a %el"(" m)la#ela #e(!"an& ma$a dalam Ja$#" F min&&" $ada(/CH a$an $em!ali n)(mal7

•

Kem)#e(a*i !e("*a me#)#(e$%a# da$#in)mi%in a#a"$)m!ina%i $ed"a )!a# #e(%e!"#7 ?koriokarsinoma


93/120

KELAINAN KEHAMILANPADA ?ANIN

LO 7


94/120

A!)(#"%

Be(a$i(na %"a#" $eamilan%e!el"m ,anin mam*" id"* dil"a(

(aim ?G 500 &(am a#a"G 20


95/120

-eni%

%*)n#an

A!)(#"%!"a#an

P().)$a#"%#e(a*e#i$ ?a!

*().)$a#"%medi%inali%

P().)$a#"%$(iminali%

in#e(.en%i da(i l"a(

*en&&"&"(anQa!)(%iQa!)(#"% *().)$a#"%

a#a% indi$a%i #e(a*e#i$medi%

a!)(%iQ*en&&"&"(an

Manie%#a%i Klini%


96/120

Manie%#a%i Klini%• @e(lam!a# aid a#a" amen)(e G 20

min&&"• Peme(i$%aan :%i$

– $eadaan "m"m #am*a$ lema $e%ada(anmen"("n

– #e$anan da(a n)(mal a#a" men"("n – den"# nadi n)(mal a#a" =e*a# dan $e=il – %"" !adan n)(mal a#a" menin&$a#

• Pe(da(aan *e(.a&inam m"n&$in di%e(#aiden&an $el"a(na ,a(in&an a%il $)n%e*%i

•

Ra%a m"la% a#a" $(am *e("# didae(a a#a%%im:%i% %e(in& ne(i *in&an& a$i!a#$)n#(a$%i "#e("%

• Peme(i$%aan &ine$)l)&i


97/120

• Peme(i$%aan &ine$)l)&i a7 nspeksi Vulva – *e(da(aan *e(.a&inam ada a#a" #ida$ ,a(in&an a%il

$)n%e*%i – #e(=i"m !a" !"%"$ da(i ."l.a

!7nspekulo – *e(da(aan da(i =a."m "#e(i – )%#e"m "#e(i #e(!"$a a#a" %"da #e(#"#"* –

ada a#a" #ida$ ,a(in&an $el"a( da(i )%#i"m – ada a#a" #ida$ =ai(an a#a" ,a(in&an !e(!a" !"%"$ da(i

)%#i"m

=7 !olok vagina – *)(%i) ma%i #e(!"$a a#a" %"da #e(#"#"* – #e(a!a a#a" #ida$ ,a(in&an dalam =a."m "#e(i – !e%a( "#e("% %e%"ai a#a" le!i $e=il da(i "%ia $eamilan – #ida$ ne(i %aa# *)(%i) di&)an& – #ida$ ne(i *ada *e(a!aan adne$%a – =a."m d)"&la% #ida$ men)n,)l dan #ida$ ne(i

E#i)l)&i


98/120

&• Kelainan *e($em!an&an ;&)# 496

den&an de&ene(a%i em!(i) ?!li&#ed )."m• 50 0 6 di%e!a!$an $elainan $()m)%)m

da(i a%il $)n%e*%i• a$#)( ma#e(nal•

Pena$i# ine$%i• Han&&"an n"#(i%i an& !e(a#• Pena$i# $()ni%• Al$))li$ dan *e()$)$•

An)mali "#e("% dan %e(.i$%• Han&&"an imm"n)l)&i%• @(a"ma

Pa#):%i)l)&i


99/120

&• AJal a!)(#"% #e(,adi perdarahan desiduabasalis dii$"#i

den&an nerkrosis jaringan sekitar an& mene!a!$an

a%il $)n%e*%i #e(le*a% + dian&&a* !enda a%in& dalam"#e("%7 Kem"dian "#e("% !e($)n#(a$%i "n#"$men&el"a($an !enda a%in& #e(%e!"#

• Pada $eamilan G F min&&" .illi $)(iali% !el"m menem!"%de%id"a %e=a(a dalam ,adi a%il $)n%e*%i da*a# di$el"a($an

%el"("na• Pada $eamilan F


100/120

Dia&n)%i% Bandin&

• Keamilan e#)*i$ #e(&an&&"• M)la ida#id)%a

• Kemamilan den&an $elainan %e(.i$%7

• A!)(#i)n imi#ein% *e(l" di!eda$anden&an *e(da(aan im*lan#a%i an&!ia%ana %edi$i# !e(Ja(na me(a

=e*a# #e(en#i dan #ida$ di%e(#aim"le%


101/120

K)m*li$a%i Se&e(a la$"$an *enilaian #anda


102/120

" # $ K

Perdarahan hebat

NFEK" %"EP""

Protokols&okhipovolemik

dia%#)li$ G 0 mm/&Y P"=a# ? #e("#ama *al*e!(a #ela*a$ #an&an dan !i!i(Y Be($e(in&a# !ana$ &eli%a a*a#i% a#a" $eilan&an$e%ada(anY Pe(naa%an =e*a# ? 30Zm#

Y Pe(da(aan !ana$ me(a %e&a( den&an#an*a!e$"anY Da(a mem!a%ai *a$aian $ain %elim"# d%!Y P"=a# ?$)n,"=#i.a *al*e!(a #an&an dan !i!i(Y P"%in& $e%ada(an men"("n

• Demam #in&&i ?3F C men&&i&il !e($e(in&a#Y Se$(e# .a&inan !e(!a"Y Ka$" dan #e&an& *ada dindin& *e("# !aJaY Cai(an m"$)*"("len melal"i )%#i"m %e(.i$%Y Ne(i &)an& %e(.i$%Y Pe(da(aanY Se*%i%Y Deid(a%iY Rea$%i .a%)


103/120

P Pen"n,an&


104/120

P7Pen"n,an&

• Peme(i$%aan la!)(a#)(i"m – Ka(i)#i$ da(a #e*i $ed"a )(an& #"a – /i%#e()%an&)&(a: dii$"#i den&an i%#e()%$)*i a#a"

la*a()%$)*i !ila ada indi$a%i – Bi)*%i end)me#(i"m *ada a%e l"#eal – Peme(i$%aan )(m)n @S/ dan an#i!)di an#i #i()id – An#i!)di an#i)%)li*id ?=a(di)li*in )%a#idil%e(in – L"*"% an#i$)a&"lan ?a*a(#ial #()m!)*la%#in #ime a#a"

("%%el .i*e( .en)m – Peme(i$%aan da(a len&$a* #e(ma%"$ #()m!)%i# –

K"l#"( =ai(an %e(.i$% ?m=)*la%ma "(ea*la%ma=lamdia !ila di*e(l"$an

DISPROPORSI KEPALAPANHHUL

an#a(a $e*ala ,anin den&an*an&&"l i!" %edemi$ian ("*a


105/120

PANHHUL• Di%*()*)(%i $e*ala *an&&"ladala $eadaan an&

men&&am!a($an

$e#ida$%e%"aian an#a(a

$e*ala ,anin dan *an&&"l

i!" %ein&&a ,anin #ida$da*a# $el"a( melal"i .a&ina7

• DKP da*a# di%e!a!$an )le

*an&&"l %em*i# ,anin an&

!e%a( a#a"*"n $)m!ina%i

an#a(a $ed"ana

%ein&&a men&alan&i

#e(,adina *e(%alinan *e(

.a&inam dalam $)ndi%i )*#imal

%e$ali*"n

• DKP #elati! ,i$a a$i!a#

$elainan le#a$ $elainan *)%i%i

a#a" $elainan dee$%i

%edemi$ian ("*a %ein&&a

men&alan&i *e(%alinan *e(

.a&inam7

@akto# ?anin @akto# Mate#nal


106/120

•

a$#)( a!%)l"# – Bai an& !e%a(

den&an BB4000&(

– Bai d& d()=e*al"%

• a$#)( (ela#i – Mal*)%i%i ?*(e%en#a%i

m"$a *(%en#a%i dai$e*ala dee$%i

• Pe("!aan !en#"$ $a(ena $elainan*e("!aan in#(a"#e(ine

a Pan&&"l Nae&ele

! Pan&&"l R)!e(#

= S*li# *el.i%

d Pan&&"l a%imila%i

• Pe("!aan !en#"$ $a(ena *ena$i#*ada #"lan&


107/120

Dia&n)%i% DKP

• Anamne%i% #in&&i !adan i!" ?G150=m (iJaa# *e(%alinan an& %e!el"mna*ena$i# a#a" $elainan #"lan&

•

P :%i$ O%!)(n #e%# dan M"lle( M"n()Ke(( *en&"$"(an #in&&i !adan

• Pel.ime#(i $lini% a#a" (adi)l)&i% "n#"$

men&"$"( "$"(an *an&&"l• -anin !e%a(

KELAINAN -ANIN


108/120

KELAINAN -ANIN

Kema#ian ,anin *ene!a!

A7 Kema#ian -aninPa#)l)&i 17 Ri&)( m)(#i%2 [ ,am *)%# m)(#em $mdn lema% $em!ali


109/120

& & , *27 Ma%e(a%i ILe*" *d $"li# m"la !e(i%i =ai(an ,e(ni $mdn

,d me(a !e(lan&%"n& %*i 4F ,am $ema#ian37 Ma%e(a%i IILe*" *e=a Ja(na $e#"!an me(a =)$la#

4F ,am %#l $ema#ian47 Ma%e(a%i III3 m&& *)%#m)(#em7 -anin % lema% "!an#a( #"lan&2 l)n&&a( edema !aJa $"li#

He,ala 17 B-A #a$ #e(den&a(27 Raim #a$ mem!e%a( + U #"("n

37 Pe(&e(a$an ana$ #a$ #e(a!a47 Pal*a%i m,d #d$ ,ela%57 R !i)l)&i% ?


110/120

Anen=e*al"%* ,

)#a$ + a#a* #en&$)(a$ #d$ ada•B$ *d !ai *e(em*"an•Dia&n)%a

a USH! Pal*a%i $ed"a ","n& l"na$= Pada id(amni)n $em"n&$inan anen%eal (%

)#) ()n#&enUSHd @e$anan *d $e*ala %aa# V@ #im!"l &e(a$ #i!a2

+ B-A melam!a#

27/d()=e*al"%

•Kele!ian =ai(an %e(e!()%*inal dlm .en#(i$el )#a$ 500 1500 ==•Se!a!$an $e*ala !e%a(•Kadan& di%e(#ai %*ina !i:da + id(amni)n•Se(in& %e!a!$an di%#)%ia

37 S*ina Bi:da •L"!an& *d ("a% #l& !ela$an&•Se(in& di l"m!)%a$(al•%ela*"# S@ !l$& men)n,)l ?menin&)$el•S@ !l$& i$"# $el"a( ?menin&)mel)$el•Lind"n&i d( #(a"ma + ine$%i• @ )*e(a%i

47 Pena$i# •Q M)n&)li%m"%


111/120

D)Jn

&Ke*ala $e=il )$%i*"# da#a( ma#a !e(de$a#an +=ela ma#a %em*i#

@an&an ,a(i *ende$ + #e!al

Lida !e%a( $a%a( + (e#a$


112/120

%"m!in& danlan&i# lan&i#!ela

*

117Menin&)=ele

Sela*"# )#a$ men)n,)l $el"a( *d %ela #en&$)(a$Se(in& di!l$& $e*alaEn%eal)$el !ila ,a( )#a$ i$"# men)n,)l $el"a(

127 /e(nia •/e(nia "m!ili$ali% in&"inali% ,a(an& in$a(%e(a#a•Ke=il d*# %em!" %endi(i

•Be%a( )*e(a%i137 @"#"nna#e%#e%

•N)(mal *d a#e(m #e%#i% #"("n $e %$()#"m mll $anali%in&"inali%•Bila #d$ #e(,d "nde%=en%"% #e%#i="l)("m• @ )(m)n $)(i)&)nad)#()*in

147 A#(e%ia ani •

L"!an& an"% #e(#"#"* (e$#"m !"n#"• @ )*e(a%i %e&e(a

157 Pe("#!en&$a$

•Ca"%aA%i#e%Ki%#a &in,al !aJaanA#(e%ia "(e#(a $and"n& $emi *en"

Ine$%i in#(a "#e(in?$a(i)amni)ni#i%


113/120

?$a(i)amni)ni#i%De:ni%i < K)(i)amni)ni#i% adala ine$%i *ada $)(i)n dan amni)n

< K)(i)amni)ni#i% adala dia&n)%i% $lini% an& di#e&a$$an!ila di#em"$an demam 3F0C den&an 2 a#a" le!i #anda!e(i$"# inile"$)%i#)%i% 157000 %elmm3den"# ,an#"n& ,anin 10 $alimeni#(e$"en%i nadi i!" 100 $alimeni#ne(i #e$an "nd"% %aa# #ida$ !e($)n#(a$%i=ai(an amni)n !e(!a"

a$#)(*(edi%*)%i%i

- Pe(%alinan *(ema#"(- Pe(%alinan lama- Ke#"!an *e=a lama- Peme(i$%aan dalam an& dila$"$an !e("lan&


114/120

Pla%en#a *(e.ia

De:ni%i Im*lan#a%i *la%en#a *ada %e&men !aJa "#e("% a#a"men"#"*i )%#i"m "#e(i in#e(n"m7In%iden menin&$a# *ada Jani#a amil den&an (iJaa#


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