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Hypertensive Disorder

in Pregnancy
Oleh. Hj. Siti Isye Nasripah

Penyakit Hipertensi pada


Kehamilan
1.
2.
3.
4.
5.

Gestational hypertension ( Hipertensi


dalam Kehamilan )
Preeclampsia
Eclampsia
Superimposed Preeclampsia
Chronic Hypertension

Epidemiologi

One

of the deadly triad (hemorrhage,


infection)
3,7 % of all pregnancy

Gestasional hypertension
BP >

140/90 mmHg, setelah usia


kehamilan > 20 minggu tanpa adanya
riwayat HT
No proteinuria
BP return to normal < 12 weeks (3 bulan)
post partum

Preeclampsia
Mild
-

:
BP > 140/90 mmHg after 20 weeks
gestation
Proteinuria > 300 mg/24 hours or > 1+
dipstick
Edema generalisata

Preeclampsia
Severe
-

BP > 160/110 mm Hg
Proteinuria 2 g/24 hours or > 2+ dipstick
Serum Creatinin > 1,2 mg/dL
Platelets < 100.000/mm3
Increase LDH
Elevated AST/ALT
Persistent headache or other cerebral or
visual disturbance
Persistent epigastric pain

Eclampsia
Seizures

that cannot be attributed to other


causes in women with preeclampsia
Coma

Superimposed preeclampsia
New

onset proteinuria > 300mg/24 hours


in hypertensive women but no proteinuria
before 20 weeks gestasion
Sign and symptoms severe preeclampsia

Chronic Hypertension
BP >

140 mmHg before pregnancy or


diagnosed before 20 weeks gestation

Risk Factor Preeclampsia


Nulliparous

(85%)
Multiple pregnancy
History of chronic hypertension
Maternal age over 35 years
Obesitas
Sosial ekonomi
Genetik

Patophyisiology Preeclampsia
Maternal

vascular desease
Faulty placentation (cacat)
Excessive trophoblast (terlalu banyak)
Reduced

uteroplacental perfusion

Endothelial

activation

Endothelial activation
Vasospasme
-Hypertension
-Seizure
-Oliguria
-Abruption
-Liver ischemia

Capillary

Activation of coagulatio

Thrombocytopeni
Edema
Proteinuria
Hemoconcentration

Mild Preeclampsia
>

37 weeks gestasion : induction of labour


< 37 weeks gestasion :
-

No medication
No diuretik
Limitation activity
ANC 2x/weeks : Blood Pressure, proteinuria,
refleks, fetal surveillance

Management severe
1.

Delivery is the cure for preeclampsia


> 35 weeks gestation : induction of labor
< 35 weeks gestation, no complication: expectant
( the hope that few more weeks in utero will reduce
the risk of neonatal mortality and morbidity )
-

Anti hypertension
Lung maturation : dexametason 12 mg/day
(sediaan: 6 mg), 2 days
Observation : Blood pressure, symptom impanding
eclampsia, lab., fetal surveillance any disturbance
termination

Management
2. Anti hypertensive Drug
-blocking agent : labetolol
Calcium channel blocker : nifedipine
ACE inhibitor
(Angiotensin-converting-enzyme): should be
avoided : oligohidramnios, IUGR, pulmonary
hypoplasia, etc
Methyldopa : delayed onset (long-acting)

Management
3. Preventive and control convulsion
- MgSO4 : control convulsion without central
nervous system depression
- i.v : 4-6 g loading dose diluted in 100 ml of iv
fluid 15-20 min, maintenance 1-2 g/ hour in
100 ml
- i.m : 4 g in both buttock, maintenance
(stabilisasi 3 jam) 4g in one buttock,and then
after 6h, 4g in other buttock.

Management

Before giving MgSO4 :


1.
2.
3.

The patellar refleks is present


Respiration are not depressed ( RR>16/min)
Urin output > 100ml/4 hour

MgSo4 is discontinued 24 h after delivery


MgSO4 toxicity : respiratory depression,
paralysis, and arrest
Antidotum MgSO4 : calcium gluconate

Complication
1.

Eclampsia

Generalized tonic-clonic seizures


Coma without convulsion
Cerebral edema
ICU

Complication
2. HELLP Syndrome
-

Hemolysis : fragmented erythrocyte, bilirubun >


1,2 ml/dL
Elevated Lever enzymes : SGOT > 72 IU/L, LDH
> 600IU/L
Low Platelet count : < 100.000/mm3
DIC
Tx : dexamethason 2 x 10 mg, then 2 x 5 mg

Complication
3. Pulmonary edema
-

Tachypneu/dyspnea
Respiratory distress
Severe hypoxemia
Diffuse rales in both lung
ICU, ventilator
Furosemid

Complication
4. Acut Renal Failure
5. Hepatic rupture
6. Abruptio placentae
7. Cerebral hemorrhage
8. Visual disturbances

TERIMAKASIH