1

 Laporan Kasus
Kasus

EKLAMSIA
EKLAMSIA POST PARTUM
PARTUM
Diajukan Sebagai Salah Satu Tugas Dalam Menjalani Kepaniteraan Klinik Senior 
 pada Bagian/SMF Kardiologi dan Kedokteran
Kedokteran Vaskular
Vaskular RSUDZ/FK
RSUDZ/FK Uns!iah
 Banda "eh

Oleh:

RUDIYANTO
1407101030314
ANDRY KHAIRANI
1407101030269
DIDYA HAFSAH FITRIANDA

Pem!m!"#:
DR$%&$ M'h$ A"%(l()* S+$O,

-A,IAN. SMF ILMU KE-IDANAN DAN KANDUN,AN

FAKULT
FAKULTAS
AS KEDOKTERAN
KEDOKTER AN UNI/ERSITAS
UNI/ ERSITAS SYIAH KUALA
RSUD D&$
D &$ AINOEL A-IDIN
-ANDA AEH
2016
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KATA PEN,ANTAR 
#uji s!ukur penulis panjatkan ke hadirat llah S$T% karena atas berkat
rahm
rahmat
at dan
dan hida
hida!a
!ah&'
h&'!
!a% penu
penuli
lisan
san lapora
laporan
n kasu
kasuss ini
ini telah
telah dapa
dapatt penu
penuli
liss
selesaikan( Selanjutn!a shala)at dan salam penulis panjatkan kepangkuan 'abi
Muhammad S$ !ang telah membimbing umat manusia dari alam kegelapan ke
alam !ang penuh dengan ilmu pengetahuan(
dapun laporan kasus dengan judul  Eklamsia Post Partum ini diajukan
Post Partum
sebagai
sebagai salah
salah satu
satu tugas
tugas dalam
dalam menjala
menjalani
ni Kepani
Kepaniter
teraan
aan Klinik
Klinik Senior
Senior pada
pada
Bagian/SMF Kardiologi dan Kedokteran Vaskular Fakultas Kedokteran Uns!iah /
B*UD Rumah Sakit Umum Dr( Zainoel bidin Banda "eh(
U"apan
U"apan terima
terima kasih
kasih penuli
penuliss sampai
sampaikan
kan kepada
kepada Dr(
Dr(dr(
dr( Moh(
Moh( ndal
ndalas%
as%
Sp(+
Sp(+,
, !ang
!ang tela
telah
h berse
bersedi
diaa melua
meluang
ngka
kan
n )akt
)aktu
u membi
membimb
mbin
ing
g penu
penuli
liss untu
untuk 
k 
 penulisan tugas ini( #enulis juga mengu"apkan terima
te rima kasih kepada para sahabat
dan rekan&rekan !ang telah memberikan dorongan moril dan materil sehingga
tugas ini dapat selesai pada )aktun!a(

Banda "eh% Februari -.0

  #enulis
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-A- I
PENDAHULUAN

2klampsia ialah kejang pada )anita hamil dengan preeklampsia !ang tidak 
disebabkan oleh pen!ebab lain( #reeklampsia merupakan suatu kumpulan gejala
 pada ibu hamil !ang ditandai dengan peningkatan tekanan darah sistolik < 7.
mm3g dan diastolik < ;. mm3g dan proteinuria pada usia kehamilan < -.
minggu
minggu(( #rotein
#roteinuria
uria ialah
ialah ekskre
ekskresi
si protei
protein
n dalam
dalam urin
urin !ang
!ang melebih
melebihii 5.. mg
dalam -7 jam% rasio protein=kreatin
protein=kreatinin
in urin < .%5 atau adan!a protein seban!ak 5.
mg>d*(?@

2klampsia dan preeklampsia sering terjadi pada ibu muda dan nulipara%
obesitas% kehamilan ganda% usia lebih dari 58 tahun dan etnis 6rika&merika( 1bu
dengan ri)a!at diabetes melitus% hipertensi dan pen!akit ginjal juga memiliki
kerentanan terhadap pen!akit ini(

2klampsia
2klampsia dan preeklampsia
preeklampsia terjadi sekitar  dalam -... kelahiran( #ada
national Vital Statisti"s Report men!ebutkan insidensi di merika Serikat pada
tahun ;;: sekitar =5-8. kehamilan(
kehamilan( Menurut  Royal College of Obstetricians
and Gynaecologists dilaporkan
Gynaecologists  dilaporkan sekitar =-...(

,anggu
,angguan
an hiperte
hipertensi
nsi merupa
merupakan
kan kompli
komplikas
kasii medis
medis !ang
!ang paling
paling umum
umum
!ang dapat terjadi pada kehamilan% mempengaruhi sekitar 8A sampai .A dari
seluruh
seluruh kehami
kehamilan
lan(( ,anggu
,angguan
an ini bertan
bertanggu
ggung
ng ja)ab
ja)ab terhad
terhadap
ap sekita
sekitarr 0A
kematian ibu akibat hipertensi dalam kehamilan% dan 5.  7.A dari kematian
 perinatal di 1ndonesia( Tinggin!a
Tinggin!a angka kematian !ang disebabkan hipertensi
dalam kehamilan merupakan masalah di bidang obstetri( Menurut data kesehatan
indonesia -..9 angka kematian ibu ?K1@ dinilai masih "ukup tinggi% sekitar 
--:/.
--:/..(.
.(...
.. pada
pada tahun
tahun -..9(
-..9( #eneli
#enelitian
tian terakhir
terakhir di Medan
Medan oleh
oleh ,!&)("# ES
2004 melaporkan angka kejadian preeklamsia berat di RSU#( 3( dam Malik 
2004
dan RSUD Dr( #irngadi Medan pada tahun -...  -..5 adalah 8(;7A% sedangkan
eklamsia
eklamsia (.9A Disamping
Disamping perdarahan
perdarahan dan in6eksi preeklampsia
preeklampsia impending
impending
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2klam
2klamps
psia
ia dibe
dibeda
daka
kan
n menj
menjad
adii ekla
eklamp
mpsia
sia graC
graCid
idaru
arum
m ?ante
?antepa
part
rtum
um@%
@%
eklampsia
eklampsia partuirentum
partuirentum ?intrapartum
?intrapartum@%
@% dan eklampsia
eklampsia puerperale
puerperale ?postpartum@
?postpartum@%%
 berdasarkan saat timbuln!a serangan( 2klampsia ban!ak terjadi pada trimester 
terakhi
terakhirr dan semaki
semakin
n mening
meningkat
kat saat mendek
mendekati
ati kelahi
kelahiran
ran(( #ada
#ada kasus
kasus !ang
!ang
 jarang% eklampsia terjadi pada usia kehamilan kurang dari -. minggu( Sekitar 
98A
98A kejan
kejang
g eklam
eklamps
psia
ia terja
terjadi
di sebe
sebelu
lum
m melah
melahirk
irkan
an%% Sert
Sertaa 8.A
8.A saat
saat 7: jam
 pertama setelah melahirkan% tetapi kejang juga dapat timbul setelah 0 minggu
 postpartum(
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-A- 2

TIN5AUAN PUSTAKA

2$1 De!"!)!

2klampsia adalah kejang !ang terjadi pada ibu hamil denganpreeklampsia(

#re&eklampsia sendiri merupakan hipertensi bersamaan dengan proteinuria !ang
terjadi
terjadi pada
pada usia
usia kehami
kehamilan
lan lebih
lebih dari
dari -. minggu
minggu(,e
(,ejala
jala hipert
hipertensi
ensi biasan!
biasan!aa
mun"ul lebih dulu dari pada tanda lain(
2$2 E+!%em!'l'#!
2klampsia dibedakan menjadi eklampsia graCidarum
?antepartum@%
?antepartum@%eklamp
eklampsia
sia partuirentum
partuirentum ?intrapartum@
?intrapartum@%% dan eklampsia
eklampsia puerperale
puerperale
?postpartum@%
?postpartum@% berdasarkan
berdasarkan saat timbuln!a
timbuln!a serangan(
serangan( 2klampsia
2klampsia ban!ak
ban!ak terjadi
 pada trimester terakhir dan semakin meningkat saat
s aat mendekati kelahiran(8%: #ada
kasus !ang jarang% eklampsia terjadi pada usia kehamilan kurang dari -. minggu(
Sektar
Sektar 98A
98A kejang
kejang eklamp
eklampsia
sia terjad
terjadii sebelum
sebelum melahi
melahirka
rkan%
n% 8.A saat 7: jam
 pertama setelah melahirkan% tetapi kejang juga dapat timbul setelah 0 minggu
 postpartum(
#reeklamsi merupakan salah satu komplikasi medis !ang paling sering
dalam kehamilan% diperkirakan mengenai sekitar 8 & .A dari seluruh kehamilan
di dunia dan dilaporkan terdapat sekitar 8.(... sampai 90(... kematian setiap
tahun akibat preeklampsia( Kelainan ini merupakan pen!ebab dari sekitar 0A
kematia
kematian
n ibu di negara
negara maju(
maju( Di merik
merikaa Serikat
Serikat dilapo
dilaporka
rkan
n angka
angka kejadi
kejadian
an
 preeklamsi sekitar 8A hingga :A dari seluruh kehamilan( ngka kejadian
 preeklamsi di 1ndonesia berCariasi antara -%&:%8A( Untuk angka kejadian di
RSU# Sanglah Denpasar%
Denpasar% periode -..-&-..5
-..-&-..5 dilaporkan kejadian preeklamsi
preeklamsi
sebesar 8%:5A% pada periode -..7 & -..8 sebes ar 0%.0A ?Sudarma!asa dan Sur!a%
-..0@% sementara pada periode -..;&-..% dilaporkan sebesar 9%5A(
2$3 Kl()!!()!
Se"ara umum% hipertensi pada kehamilan dikategorikan dalam beberapa kategori=
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 b( #reeklampsia hipertensi !ang terjadi pada kehamilan setelah -. minggu

dengan
dengan tekana
tekanan
n darah
darah < 7./;.
7./;. mm3g
mm3g dan diserta
disertaii dengan
dengan protei
proteinur
nuria(
ia(
#reeklampsia dapat dikategorikan menjadi ringan% sedang% berat(
"( 2klampsia
2klampsia Kejang disertai
disertai dengan
dengan gejala preeklampsia
preeklampsia((
d( 3ipe
3iperte
rtens
nsii kron
kronis
is ialah
ialah hipe
hipert
rten
ensi
si !ang
!ang mene
meneta
tap
p oleh
oleh sebab
sebab apap
apapun
un !ang
!ang
ditemukan pada umur kehamilan kurang dari -. minggu atau hipertensi !ang
menetap setelah 0 minggu pas"a persalinan(
e( #reekla
eklam
mpsia  superimposed ialah timbuln!a preeklampsia pada )anita !ang
menderita hipertensi kronis(

Berdasarkan timbuln!a serangan eklamsia% eklamsia dibedakan menjadi 5(

Diantaran!a adalah sebagai berikut(

2klampsia di bagi menjadi - golongan =

( 2klampsia antepartum ialah eklampsia !ang terjadi sebelum persalinan ?ini

 paling sering terjadi@

E kejadian
kejadian 8. A sampai 0. A
E serangan terjadi dalam keadaan hamil

-( 2klampsia intrapartum ialah eklampsia saat persalinan(

E Kejadian sekitar 5.
5. A sampai 58 A
E Saat sedang inpartu
E Batas dengan eklampsia graCidarum sukar ditentukan terutama saat

mulai inpartu(

5( 2klampsia postpartum ialah eklampsia setelah persalinan

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2$4 P(8'!)!'l'#!
Ban!ak penelitian aktor risiko% etiologi% atau interCensi !ang terbaik untuk 
 preeklamsia sudah dilakukan dansSejumlah teori mengenai mekanisme
etiopat
etiopato6i
o6isio
siolog
logii preekl
preeklapm
apmsia
sia telah
telah ban!ak
ban!ak didisk
didiskusi
usikan
kan%% namun
namun teori&t
teori&teori
eori
etiolog
etiologii dan patoge
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dapat dibukt
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ikan
n se"ara
se"ara pasti(
pasti(
Kare
Karena
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itulah
ah pree
preekl
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arkan
an sebag
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theori
theories”.
es”. Dari ban!ak teori !ang telah dikemukakan% tidak ada satu pun teori
tersebut !ang dianggap mutlak benar( Teori&teori tersebut di antaran!a adalah ?@
teori iskemia plasenta% radikal bebas% dan dis6ungsi endotel% ?-@ teori intoleransi
imunologik antara ibu dan janin% ?5@ teori kelainan pada vaskularisasi plasenta%
plasenta%
?7@ teori adaptasi
adaptasi kardioCasku
kardioCaskular%
lar% ?8@ teori inflamasi, ?0@ teori de6isiensi giGi% dan
?9@ teori genetik ( Salah satu teori etiologi preeklamsi !ang saat ini "ukup ban!ak 
dianut adalah !aitu teori iskemia plasenta% radikal bebas% dan dis6ungsi endotel(
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menggantikan sel&sel endotel dan otot polos dinding arteri% sehingga arteri spiralis
akan kehilangan tonusn!a% dilatasi dan lumenn!a menjadi lebih lebar sehingga
aliran darah ke plasenta dan janin meningkat( #roses inCasi gelombang pertama
 berlangsung hingga umur kehamilan .&- minggu% kemudian disusul dengan
inCasi tropoblas gelombang kedua pada umur kehamilan 7&0 minggu hingga
maksimal umur kehamilan -. minggu( #roses inCasi !ang baik akan menjamin
aliran darah !ang baik menuju plasenta(
#ada preeklamsi terjadi kegagalan inCasi tropoblas ekstraCilus ke dalam
lume
lumen
n arte
arteri
ri spir
spiral
alis
is%% sehi
sehing
ngga
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tergan
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dan
men!
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in!
!a kond
kondis
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ksia
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&reo
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igen
enas
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tropob
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lass !ang
ang
meng
mengak
akib
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atkan
an prod
produk
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si radi
radika
kall beba
bebass berl
berleb
ebih
ihan
an dan
dan penu
penuru
runa
nan
n kada
kadar 
r 
antioksidan sehingga men!ebabkan suatu keadaan stress oksidati6( Stress oksidati6 
dianggap merupakan elemen penting dalam patogenesis preekla msi !ang berujung
 pada gangguan 6ungsi endotel dan pada akhirn!a menimbulkan sindroma
 preeklamsi% )alaupun peranann!a belum sepenuhn!a
sepenuhn!a dapat diuraikan(
Teori iskemia plasenta% radikal bebas% dan dis6ungsi endotel di atas telah
didukung oleh ban!ak peneliti !ang menganggap preeklamsi sebagai salah satu
 pen!akit dengan ketidak seimbangan antioksidan/oksidan( Ban!ak peneliti !ang
menemu
menemukan
kan bah)a
bah)a preekl
preeklamsi
amsi merupa
merupakan
kan keadaa
keadaan
n dengan
dengan dis6un
dis6ungsi
gsi endotel
endotel
men!eluruh
men!eluruh%% termasuk
termasuk perubahan
perubahan respon
respon Caskular
Caskular !ang kehilangan
kehilangan resistensin!a
resistensin!a
terhadap
terhadap agen&agen
agen&agen Casokonstrik
Casokonstriktor
tor seperti norepineph
norepinephrine
rine dan angiotensin
angiotensin 11%
 berkurangn!a produksi prostasiklin endothelial% dan peningkatan produksi
6ibron
6ibronekt
ektin
in selula
selular(
r( Semua
Semua gambara
gambaran
n preekla
preeklamsi
msi di atas
atas dimili
dimiliki
ki juga
juga oleh
oleh
seju
sejum
mlah
lah kela
kelain
inan
an med
medis ?atherosclerosis%
atherosclerosis% diab
diabet
etes
es%% sep
sepsis%
sis% dan "ed
"edera
era
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10

dapat
dapat mengak
mengakiba
ibatka
tkan
n terjad
terjadin!
in!aa reaksi
reaksi berant
berantai
ai dalam
dalam upa!a
upa!a untuk
untuk men"ari
men"ari
 pasangan elektronn!a( Radikal bebas merupakan produk
produk !ang senantiasa selalu
diproduksi
diproduksi dalam tubuh
tubuh manusia(
manusia( Dibandingk
Dibandingkan
an dengan
dengan keadaan
keadaan tidak hamil%
 pada saat kehamilan terdapat peningkatan produksi radikal bebas% dan pada
 preeklamsi dikatakan produksin!a lebih ban!ak lagi( Ketika produksi radikal
 bebas meningkat dan melebihi kemampuan sistim pertahanan antioksidan dalam
dalam
tubuh% maka terjadilah suatu keadaan !ang disebut stress oksidati6( Sumber radikal
 bebas dan stress oksidati6 !ang terbesar pada kehamilan diper"a!a berasal dari
stress oksidati6 !ang terjadi di plasenta% terutama mitokondria plasenta(
#ada preeklamsi% remodeling arteri spiralis sangat minimal dan perubahan
han!a terjadi pada bagian desidual arteri spiralis dan sebagian besar pembuluh
lainn!a tetap dalam keadaan Casoreakti6( Bersamaan dengan berkurangn!a inCasi
tropob
tropoblas
las ke dalam
dalam uterus
uterus dan arteri
arteri spirali
spiraliss men!e
men!ebab
babkan
kan suplai
suplai darah
darah ke
 plasenta menjadi sangat berkurang( ,angguan plasentasi ini men!ebabkan
terjadin!a hipoksia plasenta( Darah ibu !ang memasuki ruang interCilus memiliki
tekanan dan ke"epatan !ang tinggi% bersi6at sangat pulsatil% men!ebabkan Cili
 plasenta terpapar pada konsentrasi oksigen !ang ber6luktuasi( Keadaan ini
dipe
diperk
rkira
iraka
kan
n dapa
dapatt men!
men!eb
ebab
abka
kan
n "ede
"edera
ra tipe
tipe  HypoxiaReoxigenation ? H!R@%
 H!R@%
sehingga dihasilkan lebih ban!ak
ban!ak radikal bebas maka timbul
timbul suatu keadaan stress
oksida
oksidati6(
ti6( #ada
#ada keadaa
keadaan
n stress
stress oksida
oksidati6
ti6%% terdapa
terdapatt radika
radikall bebas
bebas berleb
berlebihan
ihan%%
terutama RO" 
terutama RO" % dan penurunan kapasitas anti oksidan( Radikal bebas berlebihan ini
kemudian bereaksi dengan polyunsaturated
dengan polyunsaturated fatty acids ? #$%&
 #$%&@ pada membran sel
dan lipoprotein pada plasma !ang membentuk lipid peroksida% melalui proses
lipid peroksidasi( *ipid peroksida merupakan komponen !ang sangat reakti6 dan
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11

?@ menurunn!
menurunn!aa produk
produksi
si prostasiklin
prostasiklin synthase
 synthase !ang men!ebabkan penurunan
 produksi prostasiklin
?-@
?-@ akti
aktiCa
Casi
si enG!
enG!me
me cyclooxygenase untuk sintesis tromboksan -
?5@ #enuru
#enurunan
nan dan
dan inakti
inaktiCasi
Casi '+
?7@ pening
peningkata
katan
n endot
endothel
helin
in
?8@
?8@ agre
agrega
gasi
si trom
tromb
bosit
sit pada
pada daera
aerah
h end
endotel
otel !ang
ang rusa
rusak
k !ang
ang jug
juga
menghasilkan tromboksan -
?0@ #erubahan
#erubahan khas
khas pada
pada kapiler
kapiler glomerulus
glomerulus berupa
berupa glomerular endotheliosis
?9@ #eningkatan
#eningkatan permeabilitas
permeabilitas kapiler 
kapiler 
?:@ #ening
#eningkat
katan
an 6aktor
6aktor koagula
koagulasi
si
?;@ Meningkatk
Meningkatkan
an mitogenisitas
mitogenisitas dan
dan apoptosis
apoptosis dari sel Caskular
Caskular
?.@ Meningkatkan mitogenisitas dan apoptosis dari selCaskular 
?@ Modi6ikasi oksidati6 pada D' dan protein dan
?-@ Meningkatkan ekspresi dan aktiCasi gen !ang sensitiCe terhadap reaksi
oksidasi% seperti reseptoruntuk *D* teroksidasi% molekul adhesi% 6aktor 
kemo
kemota
taks
ksis
is%% sito
sitoki
kin
n pera
perada
dang
ngan
an%r
%reg
egul
ulat
ator
or sikl
siklus
us sel
sel dan
dan matr
matriI
iI
metalloprotei
metalloproteinase(
nase( Keseluruhan
Keseluruhan dari gangguandi
gangguandis6ung
s6ungsi
si endotel
endotel di atas
se"a
se"ara
ra bers
bersam
ama&
a&sa
sama
ma dian
diangg
ggap
ap bert
bertan
angg
ggun
ung
g ja)a
ja)abm
bmen
en!
!ebab
ebabka
kan
n
timbuln!a gejala klinis preeklamsia( Stress oksidati6 !ang terjadi pada
 plasenta preeklamsi di!akini men!ebabkan terjadin!a apoptosis
sinsiti
sinsitiotr
otropo
opobla
blas%
s% !ang
!ang mening
meningkat
katkan
kan lepasn!
lepasn!aa 6ragme
6ragmen&6
n&6ragm
ragmen
en
mikroCillus ke dalam sirkulasi maternal dan memi"u timbuln!a reaksi
in6lamasi(
Stress oksidati6 juga diperkirakan dapatmengaktiCasi leukosit pada saat
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12

sebagai
sebagaiaki
akibat
bat dari
dari degrad
degradasi
asi !ang
!ang mening
meningkat
kat(( *eukos
*eukosit
it dan makro6
makro6ag
ag !ang
!ang
diaktiCasioleh in6eksi atau oleh respons imun ibu !ang berlebihan juga mungkin
menambahkan stimuli proin6lamasi !ang pada akhirn!a turut
mendukungbertambahn!aa stress oksidasi(
mendukungbertambahn!
Me("!)me Te&(%!"( S8&e)) O)!%(8! 
#en!
#en!eb
ebab
ab past
pastii stress
stress oksid
oksidat
ati6
i6 pada
pada pree
preekl
klam
amsi
si belum
belum dike
diketa
tahu
hui%
i%
tetapid
tetapididu
iduga
ga kuat
kuat berasal
berasal dari
dari tidak
tidak sempurn
sempurnan!
an!aa peruba
perubahan
han arteri
arteri spirali
spiraliss
uterus(Kegagalan remodeling pembuluh darah ini mengakibatkan terganggun!a
 per6usiplasenta dan adan!a konsentrasi oksigen !ang ber6luktuasi%
sehi
sehing
ngga
game
mem
mungk
ungkin
inka
kan
n timb
timbul
uln!
n!aa "ede
"edera
ra sesu
sesuai
ai teor
teorii "ede
"edera
ra  Hypoxia
 Reoxigenation 'H!R@%
'H!R@% !ang
!ang dike
dikena
nall juga
juga sebag
sebagai
ai "ede
"edera
ra iskem
iskemik
ik&re
&repe
per6
r6us
usii
?ischemicre
ischemicreperfu
perfusion
sion in(ury@(
in(ury@( 26ek
26ek !ang
!ang meng
mengan
angg
ggu
u dari
dari pros
proses
es  H!R adalah
dihasil
dihasilkan
kann!
n!aa radika
radikalbe
lbebas
bas%% terutam
terutamaa  RO" % dala
dalam
m jum
jumlah
lah besar
esar((  RO" dapat
dihasilkan melalui beberapa tempat% tetapi dua prinsip !ang sejauh ini menjadi
 perhatian  H!R adalah kebo"oranelektron dari rantai respirasi pada mitokondria
dan sistim
sistim  xanthinedehydrogenase!xanthine
 xanthinedehydrogenase!xanthine oxidase ? )*H!)O@(
 )*H!)O@( Dalam keadaan
aerobik
aerobik normal
normal%% elektro
elektron
n ditran
ditranspo
sporta
rtasika
sikan
n oleh
oleh enGimr
enGimrant
antai
ai respiras
respirasii pada
pada
membran dalam mitokondria sampai elektron tersebutditeruskan pada molekul
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13

 )*H!)O. )*H merubah

merubah purin menjadi asam urat melaluireduk
melaluireduksi
si nicotinamide
adenine dinucleotide ? +&*@%
 +&*@% sementara )O
sementara )O memetabolismeIantin dan hipoIantin
menj
menjad
adii asam
asam urat
urat%% mengg
menggun
unak
akan
an oksi
oksige
gen
n sebag
sebagai
ai resep
resepto
torel
relek
ektr
tron
on%% !ang
!ang
kemudian menghasilkan radikal superoksida( Dalam keadaam hipoksia dan respon
terh
terhad
adap
ap bebe
beberap
rapaa sito
sitoki
kin%
n% prod
produk
uksi
si enGim
enGim  )*H!)Omen
 )*H!)Omening
ingkat
kat dan konCer
konCersi
si
enGi
enGim
m menj
menjad
adii  )O  juga meningkat( Sementara itu%selama periode hipoksia%
substrat hipoIantin dibentuk sebagai hasil daripeme"ahan T
T#( Dengan demikian%
akibat
akibat dari
dari hipoks
hipoksia%
ia% semaki
semakin
n ban!a
ban!akhi
khipoI
poIanti
antin
n !ang
!ang terbent
terbentuk
uk dan diubah
diubah
menjadi asam urat !ang menggunakanoksigen sebagai reseptor elektron( Sehingga
ketika oksigen sebagai reseptorelektron hadir kembali dalam jumlah !ang "ukup%
maka terjadi produksi superoksida se"ara "epat dan ban!ak(
D!(#"')!) %(" ,(m(&(" Kl!"! El(m+)!(
Seluruh kejang eklampsia didahului dengan preeklampsia( #reeklampsia
dibagi menjadi ringan dan berat( #en!akit digolongkan berat bila ada satu atau
lebih tanda diba)ah ini =
@ Tekanan
Tekanan sistolik
sistolik 0.
0. mm3g atau lebih%
lebih% atau tekanan
tekanan diastolik
diastolik .
. mm3g
mm3g
atau lebih(
-@ #rotei
#roteinur
nuria
ia 8 gr atau lebih dalam
dalam -7 jam
jam 5J atau 7J pada pemeri
pemeriksa
ksaan
an
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14

Beberapa
Beberapa saat kemudian
kemudian seluruh tubuh menjadi kaku karena kontraksi
kontraksi otot !ang
men!el
men!eluru
uruh%
h% 6ase ini dapat berlan
berlangsu
gsung
ng . sampai
sampai 8 detik(
detik( #ada saat
saat !ang
!ang
 bersamaan rahang akan terbuka dan tertutup dengan keras%
keras % demikian juga hal ini
akan terjadi pada kelopak mata% otot&otot )ajah !ang lain dan akhirn!a seluruh
otot mengalami kontraksi dan relaksasi se"ara bergantian dalam )aktu !ang "epat(
Keadaa
Keadaan
n ini kadang
kadang&ka
&kadan
dang
g begitu
begitu hebatn!
hebatn!aa sehing
sehingga
ga dapat
dapat mengak
mengakibat
ibatkan
kan
 penderita terlempar dari tempat tidurn!a% bila tidak dijaga( *idah penderita dapat
tergigit oleh karena kejang otot&otot rahang( Fase ini dapat berlangsung sampai
satu menit% kemudian se"ara berangsur kontraksi otot menjadi semakin lemah dan
 jarang dan pada akhirn!a penderita tak bergerak(
Setelah kejang dia6ragma menjadi kaku dan pernapasan berhenti( Selama
 beberapa detik penderita seperti meninggal karena henti napas% namun kemudian
 penderita bernapas panjang dan dalam% selanjutn!a pernapasan kembali normal(
pabil
pabilaa tidak
tidak ditang
ditangani
ani dengan
dengan baik%
baik% kejang
kejang pertam
pertamaa ini akan
akan diikut
diikutii dengan
dengan
kejang&kejang berikutn!a !ang berCariasi dari kejang !ang ringan sampai kejang
!ang berkelanjutan !ang disebut status epileptikus(
Setelah kejang berhenti% penderita mengalami koma selama beberapa saat(
*aman!a
*aman!a koma setelah kejang eklampsia berCariasi(
berCariasi( pabila kejang !ang terjadi
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15

a( #eng
#engen
enda
dali
lian
an keja
kejang
ng deng
dengan
an Magn
Magnes
esiu
ium
m Sul6
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at dala
dalam
m dosi
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ang
dibeerikan intraCena( Dosis ini kemudian dilanjutkan dengan in6us magnesium
sul6at berkesinambungan(
 b( #emberian obat antihipertensi intermitten untuk menurunkan tekanan darah
saat dianggap terlalu tinggi(
"( Meng
Menghihind
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ari pembe
pemberia
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ali adan!
adan!aa edem
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 pembatasan pemberian "airan intraCena ke"uali terdapat kehilangan "airan
 ban!ak dan tidak menggunakan
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d( Termina
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si keha
kehami
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n(
#ember
#emberian
ian Magnesi
Magnesium
um sul6at
sul6at jalur
jalur intraC
intraCena
ena dapat
dapat diberi
diberikan
kan dosis
dosis a)al
a)al
sebesar 7 hinga 0 gram !ang dien"erkan dalam ..m* "airan 1V dan diberiksan
selama 8 hingga -. menit( Mulai dosis rumatan in6us - g/jam dalam .. m*
"airan 1V dengan ke"epatan dosis g/jam( S!arat pemberian magnesium sul6at
dengan memantau toksisitas% !aitu=

a( #eriks
#eriksaa re6leks
re6leks tend
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on dalam
dalam se"ara
se"ara berkal
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a(
 b( Tidak terdapat bradipneu dan
dan 6rekuensi na6as < 0 kali permenit(
"( Tidak
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adan!a olguria%
olguria% produksi
produksi urin
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ml/kgbb/jam
b/jam atau
atau 5.. m*/-7
m*/-7 jam(
jam(
d( Beberapa
Beberapa ahli menguku
mengukurr kadar magnesiu
magnesium m serum pada
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men!esua
men!esuaika
ikan
n ke"epa
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in6us untuk
untuk mempert
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nkan
n kadar
kadar magnesi
magnesium
um
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18

3$2$
3$2$ A"(m
A"(m"e
"e)!
)!))
.-.
.-. /eluha
/eluhan
n $tama
$tama
#erut mules mules

.-.-
.-.- Ri0ayat
Ri0ayat #enyakit
#enyakit "ekaran
"ekarang 
g 
#asien datang dengan hami ,5#-. dengan keluhan perut terasa mules(
mules(
#asien rujukan dari puskesmas dengan peningkatan
peningkatan tekanan darah%( #asien hamil
5;&7. minggu% pasien tidak ingat 3#3T tetapi pasien mengatakan bulan 7&-.8
sudah positi6 hamil saat periksa ke bidan% #asien mengatakan selama kehamilan
han!a
han!a 5I 'H( #asien berada
berada di puskesmas
puskesmas sejak pukul --(..%
--(..% pe"ah ketuban
 pukul .-(5.( saat tiba di 1,D pembukaan sebesar 0"m( Keluhan sakit kepala%
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19

3$3$
3$3$ Peme&
Peme&!
!)(
)(("
(" F!)!
F!)! 
 
.. 5ital "ign
Kesadaran = Hompos Mentis
Keadaan umum = Baik  
Tekanan darah = -../. mm3g
*aju 'adi = . I/menit
#erna6asan = -- I/menit
SuhuTubuh = 50(9 . H
..- #emeriksaan %isik 
( Kepala dan leher= mata anemis%
anemis% dan sklera tidak ikterik 
-( #aru=
#aru= simetri
simetris%
s% stem 6remitu
6remituss kananL
kananLstem
stem 6remitu
6remituss kiri% sonor
sonor pada kedua
kedua
lapangan paru% Cesikuler ?J/J@% ronki ?&/&@ dan )heeGing ?&/&@(
5( 4antung=
4antung= bun!i
bun!i jantung
jantung 1  bun!i
bun!i jantung
jantung 11% regular%
regular% murmur
murmur tidak ada(
ada(
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20

men!
men!un
unti
tika
kan
n oksit
oksitos
osis
isn
n . iu 1M%
1M% selan
selanju
jutn
tn!a
!a lahir
lahir plase
plasent
ntaa leng
lengka
kap
p dan
dan
dilakukan eCaluasi apakah terdapat sisa plasenta dan laserasi jalan lahir(

2Cal
2Calua
uasi
si pers
persal
alin
inan
an Kala
Kala 7% deng
dengan
an meni
menila
laii juml
jumlah
ah pend
pendar
arah
ahan
an sert
sertaa
mengeCaluasi kontraksi dari uterus( Bekas darah pada tubuh pasien di bersihkan
dengan larutan disin6ektan tingkat tinggi% beberapa saat kemudian pasien kejang(

TD( ;./. mmhg% 3R= 8I/1 RR=5.I/1 T=59%: drajat Hel"ius

sasment( 2klamsia #ost #artum pada #5.

Tatalaksana%
Tatalaksana% #emberian MgSo7 7.A 1V - ,ram Bolus

Kejang Teratasi(
Teratasi(
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21

o tasi Tekanan
Tekanan Darah = 'i6edipin . mg eCaluasi setiap -. menit% dapat
diuloang
diuloang seban!ak 7 kali( 4ika tensi stabil dilanjutkan dengan +dalat
+ros(
o Konsultasi = Konsultasi ke DiCi"i 'eurologi
Konsultasi ke
ke DiCisi Hardiologi
Konsultasi ke DiCisi 1lmu Kesehatan Mata

2$ Ren"ana
& Kons
Konsul
ul #en!
en!akit
akit Dala
Dalam
m
< K'")=l )(&(  
< K'")
K'")=l
=l !lm=
!lm= e)e
e)eh(
h(8(
8("
" m(8
m(8(
(
< Konsul DiCisi Feto&Maternal
o Didapatkan peningkatan SDU ?5%7@ dan oligohidramnion(
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23

Dari kasus didapatkan bah)a #asien han!a 5I 'H ke bidan( #enelitian

terbaru
terbaru men!eb
men!ebutk
utkan
an bah)a
bah)a eklamp
eklampsia
sia ban!ak
ban!ak terjadi
terjadi pada
pada ibu !ang
!ang kurang
kurang
mendapatkan pela!anan 'H !aitu sebesar 0%7A dibandingkan dengan !ang
mendapatkan 'H sebesar %;9A( Studi "ase "ontrol di Kendal menunjukkan
 bah)a pen!ebab kematian ibu terbesar
terbes ar ?8%:A@ adalah perdarahan dan eklampsia(
Kedua pen!ebab itu sebenarn!a dapat di"egah dengan pela!anan antenatal !ang
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24

ngka kejadian eklampsi

eklampsi berCariasi diberbagai negara( Makin maju suatu
 'egara% tambah tinggi kesadaran mas!arakatn!a terhadap pentingn!a arti
antenatal "are% tambah rendah angka kejadian eklampsin!a(
Frekuensi di negara&negara maju .%.8 & .%A
Frekuensi di negara&negara berkembang .%5 & .%9A
,ambaran
,ambaran klinis pada pasien dengan
dengan eklamsia%
eklamsia% biasan!a
biasan!a #enderita
#enderita tidak 
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25

-( +tak
#ada
#ada preekla
preeklamps
mpsia%
ia% kematia
kematian
n !ang
!ang tiba&ti
tiba&tiba
ba terjad
terjadii bersam
bersamaan
aan
dengan kejang atau segera setelahn!a sebagai akibat perdarahan otak !ang
hebat( 3emipelgia terjadi pada perdarahan otak !ang sublethal( #erdarahan
otak "enderung terjadi pada )anita usia tua dengan hipertensi kronik( Qang
Qang
 jarang adalah sebagai akibat
a kibat pe"ahn!a aneurisma arteri
art eri atau kelainan Casa
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