k16 - hipertensi dalam kehamilan (rhr).ppt
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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
%BS.E.RI1 3ANA!E3EN.%BS.E.RI1 3ANA!E3EN.
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%BS.E.RI1 3ANA!E3EN.%BS.E.RI1 3ANA!E3EN.
&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
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. M99== EF, M9
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