Professional Documents
Culture Documents
Asma
Penyempitan saluran napas
Ibu hamil bernapas untuk 2 orang
Oksigenisasi janin berkurang
komplikasi
Tidak terkontrol risiko meningkat
Komplikasi
Pada Janin
Kecacatan pada janin
Risiko kematian perinatal
meningkat
Retardasi pertumbuhan
intrauterin
Prematur
BBLR
Hipoksia neonatal
Pada Ibu
Preeklamsia
Hiperemesis gravidarum
Perdarahan pervaginam
Komplikasi kelahiran
lainnya
Komplikasi
KECACATAN PADA JANIN
Asthma exacerbations during the first
trimester of pregnancy were found to
significantly increase the risk of a
congenital malformation. (J Allergy Clin
Immunol 2008;121:1379-84.)
Tujuan penatalaksanaan
Kontrol optimal gejala respirasi termasuk
serangan malam
Dapat mencapai atau mendekati fungsi
paru normal
Dapat beraktivitas sehari-hari
Menghindari atau meminimalisir
serangan asma
Menjaga dan menghindari efek samping
obat terhadap ibu dan janin
Manajemen asma
1. Menggunakan pengukuran objektif
untuk penilaian dan monitoring ibu
dan janin
2. Menghindari dan mengontrol
pencetus asma
3. Manajemen rencana pengobatan
dan mengatasi serangan
4. Edukasi
5. Dukungan Psikologi
Terapi
Pelega (reliever)
Agonis beta 2
Antikolinergik
Kortikosteroid
Gol. Xantin
Pengontrol (controller)
Kortikosteroid
Sodium kromolin
Nedokromil
Teofilin SR
LABA
ketotifen
RELIEVER
Inhaled 2agonist p.r.n.
Step
down
when
controlled
RELIEVER
Inhaled 2agonist p.r.n.
RELIEVER
Inhaled 2agonist p.r.n.
Patient
education
essential at
every step
Reduce
therapy if
controlled for
at least
3 months
Continue
monitoring
RELIEVER
Inhaled 2agonist p.r.n.
Step up
if not controlled
(after check on
inhaler technique
and compliance)
Persalinan
Selama proses persalinan obat-obat
asma tetap dapat diberikan
Penyandang asma yang mendapat
steroid sistemik selama kehamilan
dianjurkan untuk mendapat steroid IV
selama dan 24 jam setelah persalinan.
Exacerbation of Asthma
(PEFR / FEV < 80% baseline
symptoms : wheeze, cough, breathlessness, or chest
tightness)
Treat exacerbation*
Inhaled beta2 agonist
IV corticostroids
Hydrocortisone (100 mg every 8 hours until postpartum
) if systemic steroids were taken within 4 weeks
Oxygen to maintain O2 saturation > 95 %
Continue efforts for vaginal delivery
Notify anesthesia consultant and paediatrician
Analgesia
-Consider fentanyl
-Consider epidural analgesia
Anesthetic, if necessary
-Pre-anesthetic atropine and glycopyrrolate
-Low concentrations of halogenated anesthetic
Continue assessment
PEFR /FEV1
Oxygen saturation
Intensive fetal monitoring (consider continuous electronic fetal
monitoring or intermittent auscultation)
Perform vaginal delivery, if possible
Respiratory failure
(PEFR /FEV < 25 % & CO2 > 35
mm Hg
Symptoms ; extreme distress,
confusion
DURING DELIVERY
Assessment at Admission
Medical History
Physical examination
Expiratory flow measurement (PEFR or
Well controlled mild, moderate, or severe asthmaFEV1)
Exacerbation of Asthma
Respiratory failure
(PEFR / FEV1 > 80% baseline, no / minimal
(PEFR / FEV < 80% baseline
(PEFR /FEV < 25 % & CO2 > 35
Oxygensymptoms
saturation
( oxymeter
or arterialmm Hg
symptoms)
: wheeze, cough,
breathlessness, or chest
Continue routine inhaled asthma medications to IV
tightness)
Symptoms ; extreme distress,
blood gas)
route
Treat exacerbation*
confusion
Administer hydrocortisone (100 mg every 8 hours
Inhaled beta2 agonist
CarefulIVfetal
monitoring
until postpartum ) if systemic steroids were takenwithin
corticostroids
4 weeks.
Analgesia
-Avoid morphine and meperidine
-Consider fentanyl
-Consider lumbal epidural with diluted concentrations
of local anesthetic and narcotics
Anesthesia, if necessary
-Pre-anesthetic atropine and glycopyrolate
-Low concentrations of halogenated anesthetics
Continue assessment
PEFR /FEV1
Oxygen saturation
Intensive fetal monitoring (consider continuous electronic fetal
monitoring or intermittent auscultation)
Perform vaginal delivery, if possible
of Asthma
Well controlled mild, moderate,Exacerbation
or/ severe
asthma
(PEFR
FEV < 80% baseline
: wheeze, cough, breathlessness, or chest
(PEFR / FEV1 > 80% baseline, symptoms
no / minimal
symptoms)
tightness)
Treat exacerbation*
Continue routine inhaled asthma
to IV route
Inhaledmedications
beta2 agonist
IV corticostroids
Administer hydrocortisone (100
mg every
hours
until
Hydrocortisone
(100 mg 8
every
8 hours until
postpartum
) if systemic steroids were taken within 4 weeks
postpartum ) if systemic steroids
were
taken
within
Oxygen
to maintain
O2 saturation
> 95 % 4 weeks.
Continue efforts for vaginal delivery
Analgesia
Notify anesthesia consultant and paediatrician
Analgesia
-Avoid morphine and meperidine
-Consider fentanyl
-Consider epidural analgesia
-Consider fentanyl
Anesthetic, if necessary
atropine and glycopyrrolate
-Consider lumbal epidural with--Pre-anesthetic
diluted
concentrations
of
Low
concentrations
of halogenated anesthetic
local anesthetic and narcotics
Anesthesia, if necessary
-Pre-anesthetic atropine and
glycopyrolate
Continue
assessment
PEFR /FEV1
-Low concentrations of halogenated
Oxygen saturation anesthetics
Intensive fetal monitoring (consider continuous electronic fetal
monitoring or intermittent auscultation)
Perform vaginal delivery, if possible
Respiratory failure
(PEFR /FEV < 25 % & CO2 > 35
mm Hg
Symptoms ; extreme distress,
confusion
Exacerbation of Asthma
Respiratory failure
(PEFR /FEV < 25 % & CO2 > 35
mm Hg
Symptoms ; extreme distress,
confusion
Continue assessment
PEFR /FEV1
Oxygen saturation
anesthesia consultationt and
Intensive fetal monitoring (consider continuous electronicNotify
fetal
paediatrician
Initiate mechanical ventilation
monitoring or intermittent auscultation)
Perform vaginal delivery, if possible
Emergency cesarean section , if necessary
Perform vaginal delivery, if possible
Exacerbation of Asthma
(PEFR / FEV < 80% baseline
symptoms : wheeze, cough, breathlessness, or chest
tightness)
Treat exacerbation*
Inhaled beta2 agonist
IV corticostroids
Hydrocortisone (100 mg every 8 hours until postpartum
) if systemic steroids were taken within 4 weeks
Oxygen to maintain O2 saturation > 95 %
Continue efforts for vaginal delivery
Notify anesthesia consultant and paediatrician
Analgesia
-Consider fentanyl
-Consider epidural analgesia
Anesthetic, if necessary
-Pre-anesthetic atropine and glycopyrrolate
-Low concentrations of halogenated anesthetic
Respiratory failure
(PEFR /FEV1 < 25 % & PCO2
> 35 mm Hg
Symptoms ; extreme distress,
confusion
TERIMA KASIH
THANK YOU
ARIGATO
DANKWELL
MATURNUWUN