LAPORAN TUTORIAL BLOK 2.

3 MODULE 3
TUTOR : Dr. Edison, MPH

OLEH : Anggota kelompok 14 B Bagus Sedayu Eka Putri Dewi Oktavia Larissa Ardelia Putri Nisha Anggia Yosantara Putra Akbara Pradana Reza Aditama Radjasa Gunasellan Letchumanan

FAKULTAS KEDOKTERAN UNIVERSITAS ANDALAS TAHUN 2011

MODULE 2: PREGNANCY pathological SCENARIO 2: PREGNANCY IS DIFFICULT

Ny. Zulaika, 42 years old, living in junction West Pasaman, has 3 children and is currently 8 months pregnant. At the time control to clinic blood pressure was found Ny.Zulaika 160/110 mmHg, edema pretibia () and urinary protein 2, so doctors clinic. Ny.Zulaika suspect had pre eclampsia. Then the doctor put an IV in the form regimen of MgSO4, the doctor also put a urinary catheter and give antihypertensive drugs.doctor This clinic is understood that preeclampsia is one cause of death Mother primary in West Sumatra, so that immediately refer to the hospitals. In hospitals, physician specialists Obsgyn make history again and note that on Ny.Zulaika 2 months of pregnancy had experienced bleeding a little but since then no bleeding ever again, and no history of hypertension outside of pregnancy. from the examination. Doctors found a high physical fundus 2 fingers above the center, FHR 140x/menit regular. Then the doctor gave explaination in the mother that this time she suffered from preeclampsia weight with the possibility of impaired fetal growth and should be done treatment and investigation of ultrasound, CTG and laboratories. Mother Zulaikapun room pathological pregnancies treated in hospitals West Pasaman. how do you explain what happens in pregnancy Ny.Zulaika ?

Terminology
1. Edema pretibia: state of the leg to swell in pregnancy due to accumulation of fluid in the leg. 2. Proteinuria: the presence of protein in urine with range 0-5 3. Pre eclampsia: hypertension arising after the age of 20 weeks gestation with proteinuria 4. Regimens: treatment patterns daitur strictly designed to achieve specific goals 5. Severe pre eclampsia: pre-eclampsia with the systole and diastole greater than 160greater than 110 6. DJJ 140 / minute: normal 140 but no variability

Identification of problems
1. What is the relationship of age with her pregnancy? 2. whether the association of edema, proteinuria, with pre eclampsia? 3. whether the symptoms - symptoms of pre eclampsia? 4. why do doctors give intravenous regimen of MgSO4? 5. what are the benefits of urine catheter and antihypertensive drugs? 6. What antihypertensive drugs administered yan doctor? 7. why pre-eclampsia one cause of death brag? 8. how preeclampsia can occur, pathology, complications, due to pre eclampsia? 9. whether the relationship bleeding 2 months of pregnancy with pre eclampsia in ny.zulaika? 10. why ny. zulaika could be pre eclampsia but no history of hypertension outside ofpregnancy? 11. why pre-eclampsia can cause growth disorders in the fetus? 12. what is the relationship ny. zulaika preeclampsia with no bleed again? 13. What ties the results of two fingers above the center, DJJ 14O times per minute,regular with age 8 months pregnancy? 14. Ultrasound examination of why it needs to do, CTG and labor? 15. What other disorders that can occur in the mother during pregnancy?

Analysis of the problem 1. risk factors over 35 years primigravida: first-time mother, primiparas: first-time mom extreme age kidney disease obesity 2. preeclampsia -> high blood pressure -> decreased blood flow in spiral arteries -> hypoxia plasma volume decreases causing hypovolemia and decreased renal blood flow, this willlead to increased membrane permeability, eventually there was proteinuria. 3. symptoms: - Increased heart rate - Impaired vision - Severe headache - Generalized edema - Blood pressure greater than 160/110 per minute - Kidney failure 4. MgSO4 function: - Preventing seizures - anticonvulsants - Inhibitor of uterine contractions -regulate blood pressure - Lowered levels of acetyl choline 5. catheter is used because the patient must lie in state,, antihypertensive drugs used to lowerblood pressure 6. nifedipine 50-10 mg orally, labetalol, a beta blocker > labetalol, sodium nitroprusside,calcium channel blockers (nimodipin, isradipin) 7. caused by fatty foods, and oily, so this increases the risk factor of hypertension 8. blood flow, failed berinvasi, there was vasoconstriction,, this leads to endothelial damage,the damaged endothelial endothelin release that is vasokontriktor,, resulting in plateletaggregation 9. vasoconstriction of the endometrium is not firmly attached to the trophoblast,, there wasbleeding 10. Other risk factors are extreme age <20 years,> 35 years 11,12. lack of placental blood flow, air and food pathways is reduced,, causing stunted growth ininfants

13. gestational age is 8 months, mean 32 weeks, while emeriksaan obtained from two fingersabove the center, which means 28 weeks, the baby is likely to grow is hampered, because the size of the baby was smaller than it should be based on her pregnancy. 14. for laboratory examination,, urine tests CTG: heart rate, there is no variability, whether normal or not normal 15. diabetes, gestational: only during pregnancy Gestational pros: grow larger thyroid disorders - Hyperthyroidism: miscarriage - Hypothyroidism: mental retardation

Learning Objectives
students are able to explain: 1. MMR and IMR and the factors that cause 2. bleeding in pregnancy 3. impaired fetal growth 4. hypertension in pregnancy 5. complications of pregnancy 6. pathological and pharmacological management of pregnancy 7. reference to high-risk pathological pregnancies 8. preventive and promotive Maternal mortality and infant mortality The risk of maternal & child deaths occur most widely in the period of birth Determinants of Maternal Mortality: 1.Pendidikan, Economics, Geography, Gender, Culture 2. Personnel, facilities, drugs, Managerial 3. Pregnant women: 4 Too, Nutrition, Disease, Other Diseases COMPLICATIONS -Bleeding -eclampsia -infectionPertus -Complications of Miscarriage Referring Late Late Up Too Late Adequate Relief dies MDGs Millennium DevelopmentGoals (MDG's) or the Millennium Development Goals is an attempt to fulfill the fundamental rights of human needs through a shared commitmentamong the 189 UN member states to implement the 8 (eight) development goals 1. Eradicate poverty and hunger, MDG1 although associated with poverty and hunger, butthe most decisive indicator is the prevalence of undernourishment and malnutrition. 2. Achieve universal primary education 3. Promote gender equality and empowerment female 4. Reducing child mortality

5.increase maternal health 6. Combating the spread of HIV / AIDS, malaria and illness other infectious 7. Environmental sustainability 8. Build a global partnership in development.