4. obsgin - dr. dr. freddy w. wagey, spog-k

8/11/2019 4. Obsgin - Dr. Dr. Freddy W. Wagey, SpOG-K

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Penyakit yang menyertai dalam

kehamilan

Freddy W Wagey

Bag./SMF Oibstetri dan Ginekologi

FK Unsrat/RSUP Prof. RD Kandouw

Manado


kehamilan

Freddy W Wagey

Bag./SMF Obstetri dan Ginekologi

FK Unsrat/RSUP Prof. RD Kandou

Manado


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kehamilan1. Penyakit traktus urinarius

2. Penyakit traktus Respiratorius

3. Penyakit jantung dalam kehamilan

4. Hipertensi dalam kehamilan

5. Diabetes mellitus dalam kehamilan6. Penyakit lain


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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


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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%


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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


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MANAGEMENT OF CHRONIC RENAL

DISEASE DURING PREGNANCY

Preconception counseling

Multidisciplinary approach

Frequent monitoring of blood pressure (every12 wk) and renal function (every mo)

Balanced diet (moderate sodium, protein)

Maintain blood pressure at 120140/8090mm Hg

Monitor for signs of preeclampsia


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1. Hypertension related to pregnancy

2. Hypertension returns to baseline

by 6 weeks postpartum3. PIH, by definition, after 20 weeks*

gestation

(* exception = GTD)

Pregnancy Induced Hypertension

(PIH)


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Free Powerpoint Templates Page 8

Definitions

1. Hypertension

2. Edema3. Proteinuria
http://www.powerpointstyles.com/http://www.powerpointstyles.com/


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Page 9

Hypertension

SBP rise of 30 mm Hg or DBP rise of 15 mm Hgis probably not significant provided sustained BP

is


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Proteinuria

1. Greater than 300 mg in 24 hour period2. Greater than 100 mg/dl dipstick

(sustainable)


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Edema

Difficult Definition

(80 + % of normal gravidas

exhibit edema)


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Pregnancy Induced

Hypertensi

1. Preeclampsia

2. Eclampsia

3. Late transient HT


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Pregnancy Induced Hypertensi

Preeclampsia = PIH with proteinuria

Eclampsia = PIH with seizure activity

Late transient HTN = HTN alone without

otherapparent organ involvement


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Preeclampsia:

A. Mild

B. Severe

1. HELLP Syndrome


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Severe Preeclampsia

BP > 160/110 mmHg

Proteinuria > 5 gm/24hr

Azotemia/oliguria (< 500mL/24

hr)

Microangiopathic hemolysisThrombocytopenia

End organ symptoms:

1. CNS 2. Visual

3. Hepatic

Intrauterine growth delay

oli oh dramnios?


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Etiology of PIH

1. Etiology still uncertain2. Mediator responses may be effect or

causal (??!!)


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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


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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
http://keluargacemara.com/kesehatan/kehamilan/diabetes-mellitus-pada-kehamilan.htmlhttp://keluargacemara.com/kesehatan/kehamilan/diabetes-mellitus-pada-kehamilan.html


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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
http://keluargacemara.com/kesehatan/kehamilan/diabetes-mellitus-pada-kehamilan.htmlhttp://keluargacemara.com/kesehatan/kehamilan/diabetes-mellitus-pada-kehamilan.html


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4. obsgin - dr. dr. freddy w. wagey, spog-k

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