Kuliah KBK Holistik (Dr. F. Wagey)

8/14/2019 Kuliah KBK Holistik (Dr. F. Wagey)

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Penyakit yang menyertai dalamkehamilan

Freddy W WageyBag./SMF Oibstetri dan GinekologiFK Unsrat/RSUP Prof. RD Kandouw

Manado

Penyakit yang menyertai dalam

kehamilan

Freddy W WageyBag./SMF Obstetri dan GinekologiFK Unsrat/RSUP Prof. RD Kandouw

Manado


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Penyakit yang menyertai dalam

kehamilan1. Penyakit traktus urinarius2. Penyakit traktus Respiratorius3. Penyakit jantung dalam kehamilan4. Hipertensi dalam kehamilan

5. Diabetes mellitus dalam kehamilan6. Penyakit lain


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Penyakit traktus urinarius

Anatomic Changes in the Kidney DuringPregnancy

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 BETWEENPREGNANCY 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 RENALDISEASE DURING PREGNANCY

Preconception counseling Multidisciplinary approach

Frequent monitoring of blood pressure (every1 2 wk) and renal function (every mo) Balanced diet (moderate sodium, protein)

Maintain blood pressure at 120 140/80 90mm Hg Monitor for signs of preeclampsia


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1. Hypertension related to pregnancy2. 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 11

Definitions

1. Hypertension2. Edema3. Proteinuria
http://www.powerpointstyles.com/http://www.powerpointstyles.com/


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Page 12

Hypertension

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


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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 gravidasexhibit edema)


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Pregnancy InducedHypertensi

1. Preeclampsia

2. Eclampsia3. 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. MildB. Severe

1. HELLP Syndrome


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Severe Preeclampsia BP > 160/110 mmHg Proteinuria > 5 gm/24hr Azotemia/oliguria (< 500mL/24hr)

Microangiopathic hemolysis Thrombocytopenia 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 orcausal (??!!)


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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 intoleransikarbohidrat ringan (toleransi glukosaterganggu) maupun berat (DM), kehamilanberlangsung

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 DMsebelumnya

40-60 % ibu DM pada kehamilan tetap DMstlh persalinan
http://keluargacemara.com/kesehatan/kehamilan/diabetes-mellitus-pada-kehamilan.htmlhttp://keluargacemara.com/kesehatan/kehamilan/diabetes-mellitus-pada-kehamilan.html


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Kuliah KBK Holistik (Dr. F. Wagey)