Penyakit Penyakityang yangmenyertai menyertaidalam dalam kehamilan kehamilan

Freddy W Wagey Bag./SMF Oibstetri dan Ginekologi FK Unsrat/RSUP Prof. RD Kandouw Manado Freddy W Wagey Bag./SMF Obstetri dan Ginekologi FK Unsrat/RSUP Prof. RD Kandouw Manado

Penyakit yang menyertai dalam kehamilan

1. 2. 3. 4. 5. 6. Penyakit traktus urinarius Penyakit traktus Respiratorius Penyakit jantung dalam kehamilan Hipertensi dalam kehamilan Diabetes mellitus dalam kehamilan Penyakit lain

Penyakit traktus urinarius

Anatomic Changes in the Kidney During Pregnancy Increased kidney size ( 1 cm) Increased renal blood flow Increased glomerular filtration rate Dilation of urinary tract

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%

INTERRELATIONSHIPS BETWEEN PREGNANCY 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

MANAGEMENT OF CHRONIC RENAL DISEASE DURING PREGNANCY

Preconception counseling Multidisciplinary approach Frequent monitoring of blood pressure (every 12 wk) and renal function (every mo) Balanced diet (moderate sodium, protein) Maintain blood pressure at 120140/8090 mm Hg Monitor for signs of preeclampsia

Pregnancy Induced Hypertension (PIH)

1. Hypertension related to pregnancy 2. Hypertension returns to baseline by 6 weeks postpartum 3. PIH, by definition, after 20 weeks* gestation (* exception = GTD)

Definitions
1. Hypertension 2. Edema 3. Proteinuria

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Hypertension
SBP rise of 30 mm Hg or DBP rise of 15 mm Hg is probably not significant provided sustained BP is <140/90 mm Hg (Villar and Sibai, 1989)

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Proteinuria
1. Greater than 300 mg in 24 hour period 2. Greater than 100 mg/dl dipstick (sustainable)

Edema
Difficult Definition (80 + % of normal gravidas exhibit edema)

Pregnancy Induced Hypertensi

1. Preeclampsia 2. Eclampsia 3. Late transient HT

Pregnancy Induced Hypertensi

Preeclampsia = PIH with proteinuria

Eclampsia = PIH with seizure activity Late transient HTN = HTN alone without other apparent organ involvement

Preeclampsia:
A. Mild B. Severe 1. HELLP Syndrome

Severe Preeclampsia
BP > 160/110 mmHg Proteinuria > 5 gm/24hr Azotemia/oliguria (< 500mL/24 hr) Microangiopathic hemolysis Thrombocytopenia End organ symptoms: 1. CNS 2. Visual 3. Hepatic Intrauterine growth delay (oligohydramnios?)

Etiology of PIH 1. Etiology still uncertain 2. Mediator responses may be effect or causal (??!!)

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

Diabetes Mellitus pada Kehamilan

DM pada kehamilan adalah intoleransi karbohidrat ringan (toleransi glukosa terganggu) maupun berat (DM), kehamilan berlangsung 1,9-3,6% kasus DM dlm kehamilan

Diabetes Mellitus pada Kehamilan

Faktor risiko : pernah melahirkan bayi 4000 g, preeklamsia, IUFD, Cacad bawaan, Usia ibu > 30 thn, riwayat DM dlm keluarga, pernah DM sebelumnya 40-60 % ibu DM pada kehamilan tetap DM stlh persalinan