Dr .

Made Bagus Dwi Aryana, SpOG Divisi OBGINSOS, Bagian Obsteri & Ginekologi FK Unud/RSUP Sanglah Denpasar

 Hypertensive

disorders: 5 -10% of all pregnancies, and together they form one member of the deadly triad, along with hemorrhage and infection, That contribute greatly to maternal morbidity and mortality rates

<20 minggu 140/90 protein - h kronis <20 minggu 140/90 protein + SUPERIMPOSED PE >20 minggu 140/90 protein - GEST HT >20 minggu 140/90 protein +1,2 PE RINGAN >20 minggu 160/110 protein +3,4 PE BERAT KEJANG EKLAMPSIA

SO4 40 % 25 CC .. 1 GRAM=2,5CC
MG

20% 25 CC 1GRAM=5CC 20% 10CC 10 CC AQUABIDESTY

MGSO4 2dXs/3

1.

2. 3. 4.

Gestational hypertensionformerly termed pregnancy-induced hypertension. If preeclampsia syndrome does not develop and hypertension resolves by 12 weeks postpartum, it is redesignated as transient hypertension Preeclampsia and eclampsia syndrome Preeclampsia syndrome superimposed on chronic hypertension Chronic hypertension

 Systolic

BP 140 or diastolic BP 90 mm Hg for first time during pregnancy No-proteinuria BP returns to normal before 12 weeks postpartum Final diagnosis made only postpartum May have other signs or symptoms of preeclampsia, for example, epigastricdiscomfort or thrombocytopenia

Minimum criteria:
BP 140/90 mm Hg after 20 weeks' gestation Proteinuria: 300 mg/24 hours, or 1+ dipstic

 BP

160/110 mm Hg Proteinuria 2.0 g/24 hours or 2+ dipstick Serum creatinine >1.2 mg/dL unless known to be previously elevated Platelets < 100,000/L Microangiopathic hemolysisincreased LDH Elevated serum transaminase levelsALT or AST Persistent headache or other cerebral or visual disturbance Persistent epigastric pain

 HELLP SGOT

SYNDROME

>70 LDH>600 PLT<100

TERMINASI

: IMPENDING E, HELLP,EKLAMPSIA

Seizures

that cannot be attributed to other causes in a woman with preeclampsia

 New-onset

proteinuria 300 mg/24 hours in hypertensive women but no proteinuria before 20 weeks' gestation A sudden increase in proteinuria or blood pressure or platelet count < 100,000/L in women with hypertension and proteinuria before 20 weeks' gestation

 BP

140/90 mm Hg before pregnancy or diagnosed before 20 weeks' gestation not attributable to gestational trophoblastic disease, or Hypertension first diagnosed after 20 weeks' gestation and persistent after 12 weeks postpartum

 Hypertension

is diagnosed empirically when appropriately taken blood pressure exceeds 140 mm Hg systolic or 90 mm Hg diastolic. Women who have a rise in pressure of 30 mm Hg systolic or 15 mm Hg diastolic should be seen more frequently. There is no doubt that eclamptic seizures develop in some women whose blood pressures have been below 140/90 mm Hg Edema is also no longer used as a diagnostic criterion because it is too common in normal pregnancy to be discriminant.

Abnormality

No severe

Severe

Diastolic blood pressure

Systolic blood pressure Proteinuria Headache

< 110 mm Hg
< 160 mm Hg 2+ Absent

110 mm Hg
160 mm Hg + Present

Visual disturbances
Upper abdominal pain Oliguria Convulsion (eclampsia)

Absent
Absent Absent Absent

Present
Present Present Present

Serum creatinine

Normal

Elevated

Abnormality Thrombocytopenia

Non-severe Absent Present

Severe

Serum transaminase elevation

Minimal

Marked

Fetal-growth restriction Pulmonary edema

Absent Absent

Obvious Present

 Headaches

or visual disturbances such as scotomata can be premonitory symptoms of eclampsia. Epigastric or right upper quadrant pain frequently accompanies hepatocellular necrosis, ischemia, and edema that stretch Glisson capsule Thrombocytopenia is also characteristic of worsening preeclampsia. It probably is caused by platelet activation and aggregation as well as micro-angiopathic hemolysis induced by severe vasospasm

Convulsions

in a woman with preeclampsia that cannot be attributed to other causes is termed Eclampsia The seizures are generalized and may appear before, during, or after labor.

Young

and nulliparous women Race and ethnicityand thus by genetic predisposition Environmental, Socioeconomic, and Seasonal influences Obesity, multifetal gestation, maternal age older than 35 years, and AfricanAmerican ethnicity

 Are

exposed to chorionic villi for the first time Are exposed to a superabundance of chorionic villi, as with twins or hydatidiform mole Have preexisting renal or cardiovascular disease Are genetically predisposed to hypertension developing during pregnancy

Stage 1 Poor Placentation

IUGR (Fetal Growth Restriction)

Stage 2 Placental Oxidative Stress

Systemic release of Placental Factorst

Systemic Implammatory Respon, endothelial ativation

Preeclampsia Syndrme

Disease of Theory

Preeclampsia

appears to be a culmination of factors:

maternal, placental, and fetal factors.

1. 2.

3.

4.

Placental implantation with abnormal trophoblastic invasion of uterine vessels Immunological maladaptive tolerance between maternal, paternal (placental), and fetal tissues Maternal maladaptation to cardiovascular or inflammatory changes of normal pregnancy Genetic factors including inherited predisposing genes as well as epigenetic influences.

Managed according to: Severity, Gestational age, and Presence of preeclampsia

The basic management objectives for any pregnancy complicated by preeclampsia are:
Termination of pregnancy with the least

possible trauma to mother and fetus Birth of an infant who subsequently thrives Complete restoration of health to the mother.

 In

many women with preeclampsia, especially those at or near term, all three objectives are served equally well by induction of labor. One of the most important clinical questions for successful management is precise knowledge of fetal age.

 Termination

of pregnancy is the only cure for preeclampsia Further management depends on:
1. Severity of preeclampsia, 2. Gestational age, and 3. Condition of the cervix.

 Multi

disiplin Anti hipertensi Anti kejang: MgSO4 Glukokortikoid:

Pematangan paru janin HELLPS Syndrome
Perlu: Dll,

NICU, Ostetrics Emergency

Maternal:

Eklampsia HELLPS Syndrome Pulmonary edema Placental abruption Hepatic dysfunction Encephalopathy Cerebro Vascular Accident Fetal(neonatal/perinatal) deaths EGA at death Low Birthweight RDS Chronic lung disease

Perinatal: