PRE EKLAMSIA

Charles Ferdinand
RSUD RAA Suwondo-UNTAR
IDENTITAS PASIEN
Nama : Ny. T
Usia : 39 th
Alamat : diketahui
Jenis Kelamin : Perempuan

Pendidikan : SMP

Pekerjaan : Petani
Agama : Islam
ANAMNESA
Keluhan Utama :
Pasien perempuan 39 th datang ke RSUD RAA
Suwondo dengan keluhan perut kencang sejak 1
minggu SMRS. Pasien dalam keadaan hamil usia
32 minggu
Keluhan Tambahan :
Sakit kepala sejak 1 bl SMRS. Sakit kepala
terasa seperti nyeri berdenyut.
ANAMNESA
Riwayat obstetri
- G4P2A1
1. Perempuan, 21 th, 2700g, lahir normal, bidan
2. Abortus usia 7 bulan
3. Laki-laki, 12 th, 2600g, lahir normal, bidan
- HPHT : ...-4-2016
- HPL : ...-1-2017
- UK : 32 minggu
Riwayat penyakit dahulu
HT (-), DM (-), Asma (-), Jantung (-)
Riwayat Penyakit keluarga
HT (-), DM (-), Asma (-), Jantung (-)
ANAMNESA
Riwayat konsumsi obat : (-)
Riwayat alergi : (-)
Riwayat KB : pil
Riwayat Operasi :-
Riwayat pijat/jamu : -/-
PEMERIKSAAN FISIK
Keadaan Umum : Tampak sakit ringan
Kesadaran : CM

Tanda vital
TD : 160/90 mmhg
Suhu : 36,3C
Nadi : 90 x/menit
RR : 28 x/menit
BB : 64 kg
 PEMERIKSAAN FISIK
Mata : CA-/-, SI -/-
Toraks
Jantung : BJ 1& 2 reg, murmur(-), gallop(-)
Paru : Vesikuler +/+
Abdomen
Inspeksi :Cembung sesuai usia kehamilan,
striae (+), TFU 27 cm
Palpasi :Supel
Leopold 1 : bulat, lunak (bokong)
Leopold 2 : Punggung kiri
Leopold 3 : bulat, keras (kepala)
Leopold 4 : Belum masuk PAP
Perkusi : Timpani
Auskultasi : Bising usus (+)normal, DJJ 126x/menit
PEMERIKSAAN PENUNJANG
Pemeriksaan Nilai Nilai normal

Hematologi

Leukosit 13,3 4,8-10 103/uL

Eritrosit 4,85 3,80 5,80 106/uL

HGB 14 12-16 g/dL

Ht 40 33 45 %

Trombosit 218 250-450 103/uL

MCV 82,5 72 88 fL

MCH 28,9 23 34 pg

MCHC 35 32 36 g/dL

GDS 92 70-125

SGOT 46,4 0-31

SGPT 58,5 0-31

Urea 44,7

Crea 0,59

Alb 2,5 (low) 3,5-5,2

Urinalisis

Protein +++ -
TATA LAKSANA
MgSO4 dari puskesmas loading dose 4gr (40%)
10 cc dalam aquades bolus RS 6 gr (40%) 15 cc
dalam RL 20 tpm.
Nifedipin 3x10 mg

Dexamethasone 1 amp/inj/iv (4x)

Metildopa 3x500 mg
PRE
EKLAMSIA
PEMBAHASAN
 EPIDEMIOLOGI
Insiden 3-7% nulipara & 1-3% multipara
Penyebab mayor kematian dan kesakitan
meternal, kelahiran preterm, kematian perinatal
& IUGR
Penyebab kematian maternal 10-15%

Pre-eclampsia: pathophysiology, diagnosis, and management

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148420/
KLASIFIKASI
1. Pre eklamsia eklamsia setelah 20 minggu
2. HT kronik (penyebab apapun) mendahului
kehamilan
3. HT kronik + superimposed preeklamsia
4. HT gestasional (setelah 20 minggu)
Pre-eclampsia: pathophysiology, diagnosis, and management
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148420/
NEW DEVELOPMENTS IN THE PATHOGENESIS OF
PREECLAMPSIA
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107338/figur
e/F1/
PATOPHYSIOLOGY
Camille E. Powe,Richard J. Levine,S. Ananth Karumanchi
http://circ.ahajournals.org/content/123/24/2856
 CLINICAL MANIFESTATION
Headaches
Tinnitus

visual disorders

brisk tendon reflexes

vigilance disorders are related to cerebral edema;

oliguria to acute renal failure;

vaginal bleeding to placental abruption;

vomiting to HELLP syndrome;

epigastric pain to subcapsular hepatic

hematoma;
dyspnea to cardiac failure.
Pre-eclampsia: pathophysiology, diagnosis, and management
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148420/
 SUPPORTIVE EXAMINATION
Complete blood count;
a blood smear to test for schistocytes;

bilirubin,ALT, AST identify potential HELPP

syndrome;
electrolyte, urea, and creatinine acute renal failure
or uremia;
24-hour proteinuria;

prothrombin, aPTT,& fibrinogen

irregular antibody screening.

Other examinations include fetal ultrasound with

Doppler velocimetry of the umbilical, cerebral, and
uterine arteries, estimation of fetal weight, and
examination of the placenta.
Pre-eclampsia: pathophysiology, diagnosis, and management
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148420/
Pre-eclampsia: pathophysiology, diagnosis, and management
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148420/
 TREATMENT
Delivery curative treatment
Delivery after corticosteroid therapy for

pulmonary maturation is necessary if any of the

following criteria is present:
persistent epigastric pain,
signs of imminent eclampsia (headaches or persistent
visual disorders),
de novo creatinine >120 mol/L,
oliguria below 20 mL/hour,
progressive HELLP syndrome,
prolonged or severe variable decelerations with short-
term variability less than 3 milliseconds.

Pre-eclampsia: pathophysiology, diagnosis, and management

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148420/
 TREATMENT

Pregnancy Hypertension: An International Journal of Womens

Cardiovascular Health journal homepage:
 TREATMENT
Antihypertensive treatment (severe pre-
eclampsia), diminish the risk of maternal
complications (cerebral hemorrhage, eclampsia,
or acute pulmonary edema).
The four drugs in France are nicardipine,
labetalol, clonidine, & dihydralazine..
Pulmonary maturation using corticosteroids.

Magnesium sulfate (MgSO4) for severe pre-

eclampsia.

Pre-eclampsia: pathophysiology, diagnosis, and management

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148420/
Pre-eclampsia: pathophysiology, diagnosis, and management
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148420/
 COMPLICATION
Mother
premature CV disease(Chronic hypertension,
ischemic heart disease, &stroke.
Neonatal
preterm delivery, fetal growth restriction,
hypoxia-related neurologic injury, perinatal
death, & long-term cardiovascular morbidity
associated with low birthweight
Children (who are relatively small at birth)
increased risk of stroke, coronary heart
disease, & metabolic syndrome in adult life
NEW DEVELOPMENTS IN THE PATHOGENESIS OF
PREECLAMPSIA