[go: up one dir, main page]
Scribd
Upload
285 views26 pages

Penyakit Kehamilan dan Manajemennya

The document discusses several diseases that can accompany pregnancy, including: 1. Urinary tract diseases such as increased kidney size and blood flow during pregnancy. Pregnant women with diabetes are at risk of issues like increased proteinuria. 2. Respiratory tract diseases. 3. Heart disease during pregnancy. 4. Hypertension during pregnancy, also known as pregnancy-induced hypertension (PIH), which can include preeclampsia and eclampsia. PIH risk factors include nulliparity, young or old age, family history, and prior severe PIH before 28 weeks. 5. Diabetes mellitus during pregnancy, which affects 1.9-3.6%

Uploaded by

Dedy Supriadi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
285 views26 pages

Penyakit Kehamilan dan Manajemennya

The document discusses several diseases that can accompany pregnancy, including: 1. Urinary tract diseases such as increased kidney size and blood flow during pregnancy. Pregnant women with diabetes are at risk of issues like increased proteinuria. 2. Respiratory tract diseases. 3. Heart disease during pregnancy. 4. Hypertension during pregnancy, also known as pregnancy-induced hypertension (PIH), which can include preeclampsia and eclampsia. PIH risk factors include nulliparity, young or old age, family history, and prior severe PIH before 28 weeks. 5. Diabetes mellitus during pregnancy, which affects 1.9-3.6%

Uploaded by

Dedy Supriadi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 26

Penyakit yang menyertai dalam

kehamilan
Freddy W Wagey
Bag./SMF Oibstetri dan Ginekologi
FK Unsrat/RSUP Prof. RD Kandouw
Manado
Penyakit yang menyertai dalam
kehamilan
Freddy W Wagey
Bag./SMF Obstetri dan Ginekologi
FK Unsrat/RSUP Prof. RD Kandou
Manado
Penyakit yang menyertai dalam
kehamilan
1. Penyakit traktus urinarius
2. Penyakit traktus Respiratorius
3. Penyakit jantung dalam kehamilan
4. Hipertensi dalam kehamilan
5. Diabetes mellitus dalam kehamilan
6. Penyakit lain
Penyakit traktus urinarius

Anatomic Changes in the Kidney During
Pregnancy
Increased kidney size ( 1 cm)
Increased renal blood flow
Increased glomerular filtration rate
Dilation of urinary tract
RENAL DISEASE CAUSED BY SYSTEMIC ILLNESS

Gestation in pregnant women with diabetic
nephropathy is complicated by the following:
Increased proteinuria, 70%
Decreased creatinine clearance, 40%
Increased blood pressure, 70%
Preeclampsia, 35%
Fetal developmental problems, 20%
Fetal demise, 6%
INTERRELATIONSHIPS BETWEEN
PREGNANCY AND RENAL DISEASE

Impact of pregnancy on renal disease
Hemodynamic changes hyperfiltration
Increased proteinuria
Intercurrent pregnancy-related illness,
eg, preeclampsia
Possibility of permanent loss
of renal function
Impact of renal disease on pregnancy
Increased risk of preeclampsia
Increased incidence of prematurity,
intrauterine growth retardation
MANAGEMENT OF CHRONIC RENAL
DISEASE DURING PREGNANCY

Preconception counseling
Multidisciplinary approach
Frequent monitoring of blood pressure (every
12 wk) and renal function (every mo)
Balanced diet (moderate sodium, protein)
Maintain blood pressure at 120140/8090
mm Hg
Monitor for signs of preeclampsia
1. Hypertension related to pregnancy
2. Hypertension returns to baseline
by 6 weeks postpartum
3. PIH, by definition, after 20 weeks*
gestation
(* exception = GTD)

Pregnancy Induced Hypertension
(PIH)
Free Powerpoint Templates
Page 8
Definitions
1. Hypertension
2. Edema
3. Proteinuria
Page 9

Hypertension
SBP rise of 30 mm Hg or DBP rise of 15 mm Hg
is probably not significant provided sustained BP
is <140/90 mm Hg

(Villar and Sibai, 1989)
Proteinuria
1. Greater than 300 mg in 24 hour period
2. Greater than 100 mg/dl dipstick
(sustainable)

Edema
Difficult Definition
(80 + % of normal gravidas
exhibit edema)

Pregnancy Induced
Hypertensi

1. Preeclampsia
2. Eclampsia
3. Late transient HT

Pregnancy Induced Hypertensi

Preeclampsia = PIH with proteinuria

Eclampsia = PIH with seizure activity

Late transient HTN = HTN alone without
other
apparent organ involvement

Preeclampsia:
A. Mild
B. Severe
1. HELLP Syndrome

Severe Preeclampsia

BP > 160/110 mmHg
Proteinuria > 5 gm/24hr
Azotemia/oliguria (< 500mL/24
hr)
Microangiopathic hemolysis
Thrombocytopenia
End organ symptoms:
1. CNS
2. Visual
3. Hepatic
Intrauterine growth delay
(oligohydramnios?)

Etiology of PIH
1. Etiology still uncertain
2. Mediator responses may be effect or
causal (??!!)

PIH Risk Factors
Nulliparity
Young or elderly gravidas
Family history
Chronic HTN
Renal disease
Antiphospholipid syndrome
Diabetes
Multiple gestation
Angiotensinogen gene T235 (?)
Previous severe PIH before 28 weeks



Diabetes Mellitus pada Kehamilan

DM pada kehamilan adalah intoleransi
karbohidrat ringan (toleransi glukosa
terganggu) maupun berat (DM), kehamilan
berlangsung
1,9-3,6% kasus DM dlm kehamilan



Diabetes Mellitus pada Kehamilan
Faktor risiko :
pernah melahirkan bayi 4000 g, preeklamsia,
IUFD, Cacad bawaan, Usia ibu > 30 thn,
riwayat DM dlm keluarga, pernah DM
sebelumnya
40-60 % ibu DM pada kehamilan tetap DM
stlh persalinan

You might also like