PERKEMBANGAN PREEKLAMSI DI

INDONESIA : PERMASALAHAN
DAN MANAJEMEN

Johanes C. Mose

Departemen Obstetri dan Ginekologi FKUP/RSHS Bandung

183

Sumber: SRS, 2014

4
Persentase tiap item komponen ANC yang diterima
ibu
selama hamil anak terakhir, Sirkesnas 2016
 Kapan terjadi Kematian?
Immpact (2004-2005): 38% sekitar persalinan dan dalam 24 jam pasca-salin; 14% periode
Nifas 8-42 hari; Banten Study II (2015-2017): 34% dan 25%
Selama persalinan & 24
jam pertama PS => Pasca Salin, terutama
1/3total kematian hari 8-42
% 50
40

30

20

10

0
Selama 1 2 3-7 8-42
kehamilan Hari sejak berakhirnya kehamilan

Immpact Banten
Study II
Insidence of Preeclampsia before NHC/I : 15.53 %
Insidence of Preeclampsia during NHC/I : 25.04 %

Note : NHC/I = National Health Coverage/ Insurance.

Before : January 2012 – December 2012 (1 year)
During : January 2016 – December 2017 (2 years)
NHC/I was implemented since 1 January 2014
Maternal Mortality Rate per 100.000 deliveries

Before NHC/I : 8 per 1,704 deliveries = 4.69

During NHC/I : 24 per 4,929 deliveries = 4.87
 Overview of Preeclampsia in Top Refferal
centers in Indonesia.
(Bachnas MA, et all. Hypertension in pregnancy. Proceeding of the 3rd Biennial
congress of ISSHP Indonesia, among 1,266 preeclampsias in 7 provincial
hospitals, 2016)

 68% terjadi pada secundi dan multigravida

 Late onset PE 68,3%, Early onset PE 31,7%
 77% faktor risiko, terdiri dari: Anemia (26%), usia lanjut
(14%), obesitas (10%)
 Perinatal death (12%), Maternal death 2%
 Jenis persalinan: 56% C section
 11% memerlukan perawatan di ICU; 40% perawatan di HCU
 Lama perawatan > 2 hari : 93% (Tidak ditanggung BPJS)
 Overview of Preeclampsia in West Jawa
( Jussuf S Effendi. Hypertension in pregnancy. Proceeding of the 3rd Biennial congress
of ISSHP Indonesia, among 11 regency hospital in west java in 2,751 preeclampsias,
2014-2015)

 Insidensi PE di Jawa Barat tahun 2014-2015 : 12,38%;

eklampsia 1,12%.

 Faktor risiko yang berperan : usia kehamilan (20-29

thn), tingkat pendidikan (SMPdan SMA), usia
kehamilan (>37 minggu) dan paritas (1-3)

 Kejadian SS pada PE : 34%. Pada non PE: 22,7%

 M
World Congress of Maternal Neonatal Medicine, London, April 2017
 95,6 % IBU HAMIL alami HIPOVITAMINOSIS VITAMIN D

n=7
Normal ( ≥ 30 ng/mL) ; 4,4 %

Insufisiensi ( 21-29 ng/mL) 25,6 %

N=41

Defisiensi (≤ 20 ng/mL) ; 70%

n=112 Rerata:

25 (OH) Vitamin D ; 16,67 ( + 7,26 ) ng/ mL

1,25 (OH) Vitamin D ; 7,7 ( + 4,86 ) ng/mL

Setyorini, dkk. The First Report of A Longitudinal Study in West Java Province , Indonesia. Do Pregnant Women Have The advantage from Living in The Equator to Avoid Vitamin D Deficiency ?.
World Congress of Maternal Neonatal Medicine, London, April 2017
 PRINSIP MANAGEMEN
PREEKLAMSI
1. DETEKSI DINI
2. PENCEGAHAN PE
3. RUJUK KE PPK 3
4. TERMINASI KEHAMILAN DAN PEMBERIAN
ANTIHIPERTENSI DAN ANTIKEJANG

5. MANAGEMEN KOMPLIKASI
 SCREENING &
PREDICTION

GESTATIONAL
12 16 < 34 > 34
AGE (WEEKS)
PREVENTION
 RISK
SCREENING &
PREDICTION
FACTORS

BIOMARKERS

UTERINE
ARTERY

GESTATIONAL
12 16 < 34 > 34
AGE (WEEKS)
PREVENTION

CALCIUM
ASPIRIN
VITAMIN D
FOLATE
LMWH
METFORMIN
PRAVASTATIN
 RISK
SCREENING &
PREDICTION
FACTORS

BIOMARKERS
SIGNS AND SYMPTOMS
UTERINE
EARLY LATE
ARTERY ONSET ONSET
PREECLAMP PREECLAMP
SIA SIA

GESTATIONAL
12 16 < 34 > 34
AGE (WEEKS)

MgSO4
ANTI HYPERTENSION
CORTICOSTEROIDS
PREVENTION &

CALCIUM
TREATMENT

ASPIRIN

TOP (DELIVERY)

TOP (DELIVERY)
VITAMIN D
FOLATE
LMWH
METFORMIN
PRAVASTATIN
RISK FACTORS

BIOMARKERS

UTERINE
ARTERY
RISK FACTORS

BIOMARKERS

UTERINE
ARTERY
RISK FACTORS
RATIO s-Flt-1/PLGF :
BIOMARKERS
Normal Pregnancy
RATIO RAT : < 38
Preeclampsia : 38-85
UTERINE Severe Preeclampsia : > 85
ARTERY
RISK FACTORS
RATIO s-Flt-1/PLGF :
BIOMARKERS
Normal Pregnancy
RATIO RAT : < 38
Preeclampsia : 38-85
UTERINE Severe Preeclampsia : > 85
ARTERY
 RISK
SCREENING &
PREDICTION
FACTORS

BIOMARKERS
SIGNS AND SYMPTOMS
UTERINE
EARLY LATE
ARTERY ONSET ONSET
PREECLAMP PREECLAMP
SIA SIA

GESTATIONAL
12 16 < 34 > 34
AGE (WEEKS)

MgSO4
ANTI HYPERTENSION
CORTICOSTEROIDS
PREVENTION &

CALCIUM
TREATMENT

ASPIRIN

TOP (DELIVERY)

TOP (DELIVERY)
VITAMIN D
FOLATE
LMWH
METFORMIN
PRAVASTATIN
 1. Calcium : 1,5-2 gram/day
CALCIUM

ASPIRIN

VITAMIN D

FOLATE

LMWH

METFORMIN

PRAVASTATIN
 1. Calcium 1,5-2 gram/day
CALCIUM
2. ASPIRIN 150 mg/day started at 12-
16 weeks of pregnancy
ASPIRIN

VITAMIN D

FOLATE

LMWH

METFORMIN

PRAVASTATIN
 1. Calcium 1,5-2 gram/day

CALCIUM 2. ASPIRIN 150 mg/day starting at 12- 16

weeks of pregnancy

ASPIRIN 3. Vitamin D : 4000 IU/day starting at 12-16

weeks of pregnancy

VITAMIN D

FOLATE

LMWH

METFORMIN

PRAVASTATIN
 1. Calcium 1,5-2 gram/day
CALCIUM
2. ASPIRIN 150 mg/day starting at 12- 16
weeks of pregnancy

ASPIRIN 3. Vitamin D : 4000 IU/day starting at 1-16

weeks of pregnancy

VITAMIN D 4. Folic Acid 400 ug/day

FOLATE

LMWH

METFORMIN

PRAVASTATIN
 1. Calcium 1,5-2 gram/day

CALCIUM 2. ASPIRIN 150 mg/day starting at 12- 16

weeks of pregnancy

ASPIRIN 3. Vitamin D : 4000 IU/day starting at 12-16

weeks of pregnancy

4. Folic Acid 400 ug/day

VITAMIN D
5. As indicated for Thrombophilia (SLE or
APS)
FOLATE

LMWH

METFORMIN

PRAVASTATIN
 1. Calcium 1,5-2 gram/day

CALCIUM 2. ASPIRIN 150 mg/day starting at 12- 16

weeks of pregnancy

ASPIRIN 3. Vitamin D : 4000 IU/day starting at 12- 16

weeks of pregnancy

4. Folic Acid 400 ug/day

VITAMIN D
5. As indicated for Thrombophilia (SLE or
APS)
FOLATE 6. As indicated for prior insulin dependent
DM or PCO

LMWH

METFORMIN

PRAVASTATIN
 1. Calcium 1,5-2 gram/day
CALCIUM 2. ASPIRIN 150 mg/day starting at 12- 16
weeks of pregnancy

ASPIRIN 3. Vitamin D : 4000 IU/day starting at 12- 16

weeks of pregnancy

VITAMIN D 4. Folic Acid 400 ug/day

5. As indicated for Thrombophilia (SLE or

APS)
FOLATE
6. As indicated for prior insulin dependent
DM or PCO
LMWH 7. As indicated for metabolic syndrome
(obese, hyperlipidemia)

METFORMIN

PRAVASTATIN
 SIMPULAN
 Penyebab utama kematian ibu di Indonesia sejak 2010
adalah : Preeklamsi dan Eklamsi mengatasi PPH
(33,07% , SRS 2014)

 Kebanyakan kematian ibu terjadi di RS (77%) dalam 24

jam pertama pasca salin

 Ada sekitar 24-33% Puskesmas tidak punya stetoskop

 Hanya 42-47% Puskesmas yang tersedia MgSO4 20%
dan 40%

 Ekstraksi vakum hanya dimiliki oleh 52% Puskesmas

 Ketersediaan dokter spesialis, tidak merata. Di
Indonesia timur : Ketersediaan dokter Anestesi
hanya 27,5%; Ahli bedah: 58,8%; Spesialis Anak:
52%, SpOG: 57%
 Ketersediaan RS Emergensi : Unit darah 47,9%;
dokter 33,5%; servis 24 jam 40,9%
 Data HKFM 2016 :
 - 68% secundi dan multipara
 - 68,3% LOPE; 31,7% EOPE
 - SC rate : 56%
 - 11% perawatan di ICU; 40% perawatan di HCU
 - Lama perawatan > 2hari : 93% tidak ditanggung
 BPJS
 Penyebab utama kematian : Edema paru
 95,6% ibu hamil mengalami defisiensi Vit D
 Pemberian vit D sebanyak 4000 IU/hari pada ibu
hamil sejak 12-16 minggu secara significant
mencegah kejadian PE