P penyu|iI meIcLc|ik Ier:ering {1:1000)

90% DMG
Komplikasi
bu
Anak
Morbiditas
Mortalitas
Penatalaksanaan yang
baik
Outcome seperti
Kehamilan normal
P icLeIe: me|iIu: ge:IcIicnc| ccc|ch
keccccn inIc|ercn:i kcrLchicrcI ccri
:ecrcng wcniIc ycng cikeIchuiperIcmc
kc|i keIikc cic :eccng hcmi|.
P icLeIe: ge:IcIicnc| Ierjcci kcrenc
ke|cincn ycng cipicu c|eh kehcmi|cn,
ciperkirckcn kcrenc Ierjccinyc
peruLchcn pccc meIcLc|i:me g|ukc:c.
P cnyck kencing {pc|iuric).
P Hcu: ccn Lcnyck minum {pc|icip:ic),
|cpcr {pc|ifcgic).
P LeIih, |e:u.
P Fenuruncn LercI Lcccn ycng Iicck ccpcI
cije|c:kcn :eLcLnyc
P Lemch Lcccn, ke:emuIcn, gcIc|,
pcnccngcn kcLur,
P ci:fung:i erek:i pccc pric,
P FruriIu: vu|vce pccc wcniIc.
%ipe 1 {ln:u|in epencenI icLeIe:
e||iIu: <l)
icLeIe: Iipe 1 ccc|ch kc:u: geneIik
ycng pccc umumnyc cimi|iki :ejck keci|
ccn memer|ukcn in:u|in cc|cm
pengencc|icn kcccr gu|c ccrch.
cipengcruhi c|eh keIuruncn cengcn
penyeLcLnyc ccc|ch kurcngnyc
penghc:i| in:u|in cc|cm IuLuh
%ipe 2 {Ncn ln:u|in epencenI
icLeIe: e||iIu: <Nl).
icLeIe: Iipe 2 . icLeIe: Iipe 2
ccc|ch kc:u: ycng Iicck
memer|ukcn in:u|in cc|cm
pengencc|icn kcccr gu|c ccrch.
P%ecri ycng |cin mengcIckcn Lchwc
cicLeIe: Iipe 2 ini ci:eLuI :eLcgci
unmc:kec" cIcu Lcru ciIemukcn
:ccI hcmi|
PFcIuI cicurigci pccc wcniIc ycng
memi|iki ciri gemuk, riwcycI ke|ucrgc
cicLeIe:, riwcycI me|chirkcn Lcyi
4 kg, riwcycI Lcyi |chir mcIi, ccn
riwcycI cLcrIu: Leru|cng.
ln:u|in :enciri ccc|ch
hcrmcn ycng memLcwc
g|ukc:c ccri ccrch mc:uk
:e cc|cm :e|-:e| IuLuh.
P|c: l : Gesfos|ono| d|obefes
ciIu : %imLu| pccc wckIu hcmi|
ccn
menghi|cng :eIe|ch
me|chirkcn.
P|c: ll : !7egesfos|ono|
d|obefes,
yo|fu:
cicLeIe: mu|ci :ejck
:eLe|um
hcmi| ccn Ler|cnjuI
:eIe|ch hcmi|.
|c: lll : !7egesfos|ono| d|obefes
yo|fu :
Pi:erIci cengcn kcmp|ikc:i
penyckiI pemLu|uh ccrch :eperIi:
P reIincpcIi,
P nefrcpcIi,
P pemLu|uh ccrch
perifer.
P07 ccri wcniIc hcmi| ycng
menceriIc icLeIe: Iermc:uk ke
cc|cm kcIegcri:
P Ge:Ic:icnc| {%ipe ll)
ccn
P ycng IergcnIung pccc
in:u|in
{ln:u|in epencenI
icLeIe:
e||iIu: = l, Iipe l).
PcurIh lnIerncIicnc| Wcrk:hcp-
Ccnference cn Ge:IcIicnc|
icLeIe:: erekcmencc:ikcn
:krining unIuk menceIek:i
icLeIe: e|iIu: Ge:Ic:icnc|
P %e: g|ukc:c ccrch t|dok d|butuhkon cpcLi|c :
c /ngkc kejccicn cicLeIe: ge:IcIicnc| pccc
ccerch Ier:eLuI rencch
c %icck ciccpcIkcn riwcycI cicLeIe: pccc
kercLcI cekcI
c U:ic < 25 Ichun
c ercI Lcccn ncrmc| :eLe|um hcmi|
c %icck memi|iki riwcycI meIcLc|i:m g|ukc:c
Iergcnggu
c %icck ccc riwcycI cL:IeIric Iergcnggu
:eLe|umnyc
c i|ckukcn Ie: gu|c ccrch
pccc kehcmi|cn 24 - 28
minggu IeruIcmc pccc
wcniIc cengcn rc: Hi:pcnik,
/frikc, /merikc, /:ic %imur,
ccn /:ic Se|cIcn
PWcniIc cengcn cLe:iIc:, riwcycI
ke|ucrgc cengcn cicLeIe:,
mengc|cmi g|ukc:uric {cir :eni
mengcncung g|ukc:c)
4 i|ckukcn Ie: gu|c ccrch
:ecepcInyc.
4 i|c cicLeIe: ge:Ic:icnc| Iicck
Iercicgnc:i: mckc pemerik:ccn
gu|c ccrch d|u|ong pccc minggu
24 - 28 kehcmi|cn
4 /Icu kcpcnpun keIikc pc:ien
menccpcI gejc|c ycng
mencncckcn keccccn
hiperg|ikemic {kcccr gu|c ci
cc|cm ccrch Ler|eLihcn)
PFenccricn {:krining ) cicLeIe:
ge:IcIicnc| ci|ckukcn unIuk
meningkcIkcn kewc:pccccn
iLu hcmi| ccn meyckinkcn
:ecrcng iLu unIuk me|ckukcn
pemerik:ccn :krining unIuk Ie:
:eIe|ch me|chirkcn.
P riIeric icgnc:i::
1. Gejc|c k|c:ik + gu|c ccrch
:ewckIu 200 mg/c|.
Gu|c ccrch :ewckIu merupckcn hc:i|
pemerik:ccn :e:ccI pccc :ucIu hcri
Icnpc memerhcIikcn wckIu mckcn
Ierckhir. /Icu:
P2. cccr gu|c ccrch puc:c
{GN) 12 mg/c|. Fuc:c
cicrIikcn pc:ien Iicck
menccpcI kc|cri IcmLchcn
:ecikiInyc 8 jcm. /Icu:
P. cccr gu|c ccrch 2 jcm pccc
%%GC {Ie:I Ic|ercn:i g|ukc:c crc| )
200 mg/c|.
P%%GC ci|ckukcn cengcn SIcnccrc
WHC, yciIu menggunckcn
LeLcn g|ukc:c ycng :eIcrc
cengcn 75 g g|ukc:c cnhicru:
ycng ci|cruIkcn cc|cm cir.
1. %igc hcri :eLe|um pemerik:ccn
IeIcp
mckcn :eperIi keLic:ccn :ehcri-
hcri
{cengcn kcrLchicrcI ycng
cukup) ccn IeIcp me|ckukcn
kegicIcn jc:mcni :eperIi Lic:c
2. erpuc:c pc|ing :ecikiI 8 jcm,
pc|ing
Lcik 10 jcm {mu|ci mc|cm hcri)
:eLe|um pemerik:ccn,
inum cir puIih Icnpc gu|c
IeIcp
ciperLc|ehkcn
. iperik:c kcccr g|ukc:c ccrch
puc:c
4. iLerikcn g|ukc:c 75 g {crcng
cewc:c),
cIcu 1,75 g/g {cnck-cnck),
ci|cruIkcn
cc|cm 250 m| cir ccn ciminum
cc|cm
wckIu 5 meniI
P5. erpuc:c kemLc|i :cmpci
pengcmLi|cn :cmpe| ccrch
unIuk
pemerik:ccn 2 jcm :eIe|ch
minum
|cruIcn g|ukc:c :e|e:ci
P. iperik:c kcccr g|ukc:c ccrch 2
jcm
:e:ucch LeLcn g|ukc:c
P 7. Se|cmc prc:e: pemerik:ccn, :uLyek
ycng
ciperik:c IeIcp i:IirchcI cengcn
Iencng.
P/pcLi|c hc:i| pemerik:ccn Iicck
memenuhi kriIeric ncrmc| cIcu
, mckc ccpcI cigc|cngkcn ke
cc|cm ke|cmpck:
%G% {%c|ercn:i G|ukc:c%ergcnggu)
cIcu
GF% {G|ukc:c crch Fuc:c
%ergcnggu) ccri hc:i| ycng
ciperc|eh.
- %G%{ Ic|ercn:i g|ukc:c Iergcnggu) :
g|ukc:c ccrch p|c:mc 2 jcm :eIe|ch
pemLeLcncn cnIcrc 140 - 1
mg/c|
- GF% {gu|c ccrch puc:c Iergcnggu)
: g|ukc:c ccrch puc:c cnIcrc 100 -
125 mg/c|.
P Femerik:ccn recuk:i urine merupckcn
Lcgicn ccri pemerik:ccn urine ruIin
ycng :e|c|u ci|ckukcn ci k|inik. Hc:i| ycng
{+) menunjukkcn cccnyc g|ukc:uric.
P eLercpc hc| ycng per|u ciingcI ccri hc:i|
pemerik:ccn recuk:i urine ccc|ch:
1. igunckcn pccc pemerik:ccn perIcmc
:ekc|i
unIuk Ie: :krining, Lukcn unIuk
menegckkcn
cicgnc:i:
Ni|ci {+) :cmpci {++++)
c. Jikc recuk:i {+): mc:ih mungkin c|eh :eLcL
|cin, :eperIi: renc| g|ukc:uric, cLcI-cLcIcn,
ccn |cinnyc
L. Fecuk:i {++) kemungkincn G: 200 -
00 mg7
c. Fecuk:i {+++) kemungkincn G: 00 -
400 mg7
c. Fecuk:i {++++)kemungkincn
G:400mg7
cpcI cigunckcn unIuk kcnIrc|
hc:i| pengcLcIcn
i|c ccc gcnggucn fung:i ginjc|,
Iicck Li:c cijccikcn peccmcn.
1. Umur |eLih ccri 0 Ichun
2. CLe:iIc: cengcn incek: mc::c IuLuh 0
kg/m2
. FiwcycI pccc ke|ucrgc {iLu cIcu cych)
4. Fernch menceriIc ge:Ic:icnc|
:eLe|umnyc
5. Fernch me|chirkcn cnck Le:cr 4.000 grcm
. /ccnyc g|ukc:uric
7. FiwcycI Lcyi ccccI Lcwccn
8. FiwcycI Lcyi |chir mcIi
. FiwcycI kegugurcn
10. FiwcycI inferIi|iIc:
11. HiperIen:i
1. Hipcg|ikemic, Ierjcci pccc encm Lu|cn
perIcmc kehcmi|cn
2. Hiperg|ikemic, Ierjcci pccc kehcmi|cn 20-
0 minggu ckiLcI re:i:Ien:i in:u|in
. lnfek:i :c|urcn kemih
4. Freek|cmp:ic
5. Hicrcmnicn
. FeIincpcIi
7. %rcumc per:c|incn ckiLcI Lcyi Le:cr
1. /LcrIu:
2. e|cincn kcngeniIc| :pI :ccrc|
cgene:i:,neurc| IuLe cefek
. Fe:pircIcry ci:Ire::
4. NecncIc| hiperg|ikemic
5. ckrc:cmic
. Hipccc|cemic
7. emcIicn perincIc| ckiLcI cicLeIik
keIcc:icc:i:
8. HiperLi|iruLinemic
1. /Icnic uIeri
2. lner:ic uIeri
. i:Ic:ic Lchu
4. Lchir mcIi.
5. Fengckhircn kehcmi|cn cengcn
Iincckcn.
FenceriIc Ge:Ic:icnc| memunyci
re:ikc ycng Iinggi Ierhcccp kcmLuhnyc
penyckiI cicLeIe: ycng pernch
ciceriIcnyc pccc :ccI hcmi|
:eLe|umnyc.
Scrcn: -8 minggu :eIe|ch me|chirkcn,
iLu Ier:eLuI me|ckukcn Ie:I p|c:mc
g|ukc:c puc:c ccn {crc| g|uk:c Ic|ercn:i
Ie:I) CG%% 75 grcm g|ukc:c. Fc:ien
gemuk penceriIc G {ge:Ic:icnc| )
, :eLciknyc mengcnIrc| , kcrenc
ciperkirckcn ckcn menjcci cc|cm 20
Ichun kemucicn
1. ieI
2. Fenyu|uhcn
. Fxe|c|:e (|ct|ncn ||:|k/c|cn |cgc}
4. CLcI: Crc| hipcg|ikemik, in:u|in
5. Ccngkck pcnkrec:
1. encegch kcmp|ikc:i ckuI ccn krcnik.
2. eningkcIkcn kuc|iIc: hicup, cengcn
mencrmc|kcn G, ccn cikcIckcn
penceriIc IerkcnIrc|, :ehinggc
:cmc cengcn crcng ncrmc|.
. Fccc iLu hcmi| cengcn ,
mencegch kcmp|ikc:i :e|cmc hcmi|,
per:c|incn, ccn kcmp|ikc:i pccc Lcyi.
1. %enIukcn kc|cri Lc:c| cengcn
menimLcng LercI Lcccn.
2. %enIukcn penggc|cngcn pc:ien:
c.Unce|we|gnt {LercI Lcccn kurcng),
L.Ncrmc|,
c.Cve|we|gnt{LercI Lcccn Ler|eLih),
c.CLe:iIc: {kegemukcn)
Fer:enIc:e = {kg)/{%inggi cccn {cm)
-100) X 1007
P Unce|we|gnt. < 07
P Ncrmc|: 0-1107
P CverweighI : 1107 - 10 7
P CLe:iIc: : 10 7
. Jeni: kegicIcn :ehcri hcri: ringcn, :eccng,
LercI, ckcn menenIukcn jum|ch kc|cri
ycng
ciIcmLchkcn. Jugc umur ccn jeni:
ke|cmin.
4. SIcIu: gizi
5. FenyckiI penyerIc
. SercI |cruI ccn kurcngi gcrcm
7. enc|i jeni: mckcncn
1.Fenyu|uhcn ccri ckIer, iccn,
FercwcI ccn ch|i gizi ci
LeLercpc FS :ucch ccc |inik
icLeIe: %erpccu.
2. Sc:crcn: FenceriIc, ke|ucrgc
penceriIc, |ingkungcn :c:ic|
penceriIc.
eningkcIkcn jum|ch in:u|in
c. Su|fcni|urec {g|ipizice Gl%S,
g|iLenc|cmice, c:L.)
L. eg|iIinice {repcg|inice,
ncIeg|inice)
c. ln:u|in injek:i
eningkcIkcn :en:iIiviIc: in:u|in
c. igucnic/meIfcrmin
L. %hiczc|icinecicne {picg|iIczcne,
rc:ig|iIczcne)
emengcruhi penyercpcn
mckcncn
c. /ccrLc:e
HcIi-hcIi ri:ikc hipcg|ikemic
Lerikcn g|ukc:c crc| {minumcn
mcni: cIcu permen)
/gcr :upcyc :
1. cccr gu|c ccrch :eLe|um mckcn 80-
120mg/c|
2. cccr gu|c ccrch 2 jcm :e:ucch mckcn <
140 mg/c|
. cccr HL/1c < 77
ehcmi|cn hcru: cicwc:i :eccrc Ie|iIi :ejck cini
unIuk
mencegch kcmp|ikc:i pccc iLu ccn jcnin.
%ujuon utomo pengoboton DM dengon hom||:
1. encegch IimLu|nyc keIc:i: ccn hipcg|ikemic.
2. encegch hiperg|ikemic ccn g|ukc:uric
:eminimc| mungkin.
.enccpci u:ic kehcmi|cn :ecpIimc| mungkin.
4. encegch cmp|ikc:i
1. ckrcvc:ku|cr: :Ircke, penyckiI jcnIung
kcrcner, u|ku:/ gcngren.
2. ikrcvc:ku|cr: reIinc {reIincpcIi) ccn
ginjc| {gcgc| ginjc| krcnik), :ycrcf {:Ircke,
neurcpcIi).
. cmc: hiperg|ikemi, hipcg|ikemi, :Ircke.
1. cpcI hcmi| ccn punyc cnck
:epcnjcng gu|c ccrch IerkcnIrc|.
2. i:crcnkcn memi|ih kcnIrc:ep:i
cengcn kcccr e:Ircgen rencch.
. cpcI memckci pi| IcmLchcn
hcrmcn prcge:Iercn.
4. lU ccpcI menimLu|kcn ri:ikc infek:i.
P %ugc::
1. %enIukcn l mc:ing - mc:ing ccn
IenIukcn kcIegcri ukurcn IuLuhnyc jugc
cieInyc.
2. %u|i:kcn pc|c mckcn :ehcI iLu hcmi|
cengcn kcIegcri
1. Iype 2 , 5 g, GN 125mg7,FF.
2. Iype 2 , 4 g, GFF 150 mg7, F.