Gestational Hypertension

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Hipertensi dalam Kehamilan
 Gestational Hypertension
International

KASUS 1
Seorang ibu, 23 tahun, G1 hamil 35 weeks datang
dirujuk bidan dengan keterangan hipertensi dan
penglihatan buram sejak 4 jam yang lalu.

PF : TD 170/110 mmHg Nadi 96 x/m

TBJ 2200 g BJJ 150 dpm
Lab : Hb 14 Ht 45 Tr 170.000 Albumin 3,0
SGPT 23 SGOT 21 LDH 650 Asam urat 7
 Gestational Hypertension
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Pertanyaan 1

Diagnosis yang anda tegakkan pada pasien ?

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Pertanyaan 1
Diagnosis yang anda tegakkan pada pasien adalah
:
a.Sindroma HELLP
b.Hipertensi dalam kehamilan
c.Eklamsia imminen
d.Buta kortikal pada preeklamsia berat
e.……..
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Pertanyaan 2

Tatalaksana awal yang anda lakukan :

a.Pemberian antihipertensi
b.N-acetyl cysteine
c. Acetylsalicylic acid
d.MgSO4
e.……….
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Pertanyaan 3

Komplikasi yang mungkin terjadi adalah :

a.Solusio plasenta
b.Eklamsia
d.Preeklamsia superimpos
e.Kebutaan menetap
f.………
 Gestational Hypertension
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Pertanyaan 4

Apa tatalaksana selanjutnya yang anda pilih?

a.Konservatif sampai aterm

b.Akhiri kehamilan
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KASUS 2
Seorang ibu, 20 tahun, G1 hamil 36 minggu
datang ke kamar bersalin dengan keluhan mules.

TD 140/100 mmHg Kontraksi 2x/10 mnt

TBJ 2400 g CTG kategori 1
Periksa dalam : portio tipis, dilatasi serviks 1 cm,
kepala di Hodge II.
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KASUS 2
Laboratorium darah :

Hb 13 Ht 42 Tr 180.000 Albumin 3,0

SGPT 25 SGOT 20 LDH 600 Asam urat 7
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Pertanyaan 1
Tatalaksana awal yang anda lakukan :
a.Pemberian antihipertensi
b.Pemberian MgSO4
c.Pematangan paru
d.Observasi
e.Tokolitik
 Gestational Hypertension

Pertanyaan 2
International

Saat observasi pasien mengeluh sakit kepala,

kemudian kejang tonik - klonik. Apa
tatalaksana yang anda diberikan :

a. Magnesium sulfat 2 g
b. Magnesium sulfat 4 g
c. Diazepam
d. Fenitoin
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Pertanyaan 3

Apa tatalaksana anda selanjutnya?

a.SC cito
b.Partus pervaginam
c.Lanjutkan observasi
d.………
 Gestational Hypertension

Kasus 3
International

Seorang ibu, 25 tahun, G1 hamil 35 minggu datang ke

kamar bersalin dengan keluhan sesak napas sejak, mules
dan keluar cairan dari kemaluan.

PF : TD 160/110 mmHg Frek napas 30 x/menit

Nadi 110 S 36,8 0C Sat 87 %
Ronki halus di kedua paru
TBJ 2000 g BJJ 160 dpm
Kontraksi reguler
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Pertanyaan 1

Perkiraan diagnosis menurut anda ?

a.Preeklamsia
b.Preeklamsia disertai edema paru
c.Hipertensi dengan pneumonia
d. Congestive heart failure
 Gestational Hypertension
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Pertanyaan 2

Apa tatalaksana awal anda pada pasien?

a.…………..
b.…………..
c.…………..
d.…………..
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Pertanyaan 3
Pada pemeriksaan dalam didapatkan pembukaan 9 cm,
selaput ketuban (+), kepala di H3+

a.Apa metode persalinan yang akan anda lakukan?

………..
b. Persiapan apa yang anda butuhkan ?
………
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KASUS 4
Seorang ibu, 18 th, dirujuk oleh PKM
dengan keterangan G1 hamil 34 minggu
hipertensi.

PF :
TD 150/100 mmHg Nadi 100 x/m
Frek napas 24 x/m S 36,5 C
Sat 98 %
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Kasus 4

USG : TBJ 1800 g ICA 8 cm

CTG kategori 2

Hasil lab darah di RS :

Hb 10 Ht 34 Tr 30.000 L 7000
SGPT 400 SGOT 320 LDH 700
Asam urat 9
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Pertanyaan 1
Apa masalah yang ada pada pasien ?
a.………..
b.………..
c. ………..
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Pertanyaan 2

Apa rencana tatalaksana anda ?

a.Akhiri kehamilan
b.Konservatif
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Pertanyaan 2
Menurut anda, persiapan apa yang dibutuhkan
jika akan melakukan pengakhiran kehamilan?
a.………
b.………
c. ………
d.………
e. ………
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Pertanyaan 3

Menurut anda, apakah pasien harus

dirujuk ?

Apa alasan anda merujuk ?

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Two hours ago, a 25 year-old woman was hospitalized at 33

weeks gestation with gestational hypertension. She is
complaining of headache and visual disturbance. Her blood
pressure is 165/115, urine is 3+ for protein.
List three(3) important components of management.
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You are asked to see a 20 year-old patient who is in for

gestational hypertension with adverse conditions at 34
weeks.
She has been receiving 2 gm / hr of MgSO4 for the past 10
hours.
When you arrive, she is sitting up in bed breathing with her
accessory muscles and receiving 100% oxygen at 7 L/min.
Vital signs: RR 16, PR 110, Temperature 36.7,
BP of 140/90. Areflexic.
What are the first two(2) steps in the immediate
management of this patient?
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A 25 year old woman presents at 34 weeks with mild

gestational hypertension. She has no other
complications. Name two(2) medications that can be
safely used in pregnancy for lowering and maintaining
blood pressure.
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A 25-year-old G1 woman at 38 weeks presents with right

upper quadrant pain. Her blood pressure is 170/105 and her
urine shows 3+ for protein.
What are your initial investigations in emergency?

What is your management plan?

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Magnesium sulphate
6 g (15 ml of MgSO4 40%)
In 500 ml Ringer Lactate/
Dextrose 5%

11/21/22
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Kadar Magnesium dalam serum pada penderita

Preeklampsi

Kadar Mg-serum pada

regimen infus 3 gram/jam vs
1 gram/jam

Sumber : Hudono L. 1989

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Kadar Mg serum pada regimen IV dan IM

Pemberian drip IV lebih stabil

dibandingkan dengan
pemberian IM
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Magnesium Level Monitoring

Mg conc (mmol/L) Effects

0.8 -1.0 Normal plasma level
1.7 -3.5 Therapeutic range
2.5 - 5.0 ECG changes (P-Q interval prolongation, widen QRS complex)
4.0 - 5.0 Reduction in deep tendon reflexes
> 5.0 Loss of deep tendon reflexes
> 7.5 Sinoatrial and atrioventricular blockade.
Respiratory paralysis and CNS depression
> 12 Cardiac arrest
 Gestational Hypertension
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Magnesium Level Monitoring

Mg conc (mmol/L)
Effects
0.8 -1.0
Normal plasma level
1.7-3.5
Therapeutic range
2.5 - 5.0ECG changes (P-Q interval prolongation, widen QRS complex)4.0 -
5.0Reduction in deep tendon reflexes> 5.0Loss of deep tendon reflexes>
7.5Sinoatrial and atrioventricular blockade. Respiratory paralysis and
CNS depression> 12Cardiac arrest
 Gestational Hypertension
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A 32-year-old G2P1 woman presents for her routine prenatal visit

at 32 weeks gestation. Her BP’s 140/90. In the past, it has been
115/75 to 130/85 throughout the pregnancy. Her weight is 105
kg. What steps do you perform as part of your initial
investigation?

Repeat blood pressure over the next three hours range from
140/90 to 155/95. What is your management plan?
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Assessment of Mother - Clinical

• Blood Pressure
- assess severity
- consistency in measuring
- relationship of high BP to CVA not seizure
• Central Nervous System
- presence and severity of headache
- vision disturbances - blurring, scotomata
- tremulousness, irritability, hyperreflexia, somnolence
- nausea and vomiting
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Assessment of Mother - Clinical

• Hematologic
- edema
- bleeding, petechiae
• Hepatic
- RUQ and epigastric pain
- nausea and vomiting
• Renal
- urine output and colour
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Assessment of Mother - Laboratory

• Hematologic
- hemoglobin, platelets, blood film
- PTT, INR, fibrinogen, FDP
- LDH, uric acid, bilirubin
• Hepatic
- ALT, AST
- (glucose, ammonia to R/O AFLP)
• Renal
- proteinuria
- creatinine, urea, uric acid
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Assessment of Fetus
• Fetal movement
• Fetal heart rate assessment
• Ultrasound for growth
• Biophysical profile
• Amniotic fluid volume
• Doppler flow studies
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 Gestational Hypertension
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 Gestational Hypertension
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 Gestational Hypertension
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 Gestational Hypertension
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 Gestational Hypertension
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