PLENO TUTORIAL

SKENARIO B BLOK 24
KELOMPOK B8
• M Billy Darisma 04011181520127
• Ilsyafitri Bonita 04011381520094
• Dita Marisca 04011381520098
• M. Ammar Luthfi 04011381520100
• Zabila Adwie P 04011381520109
• Andika Diaz M 04011381520101
• Bhagatdeep Kaur Kaur 04011381520185
• M. Ikmal 04011381520187
• Nur Fatihahemani 04011381520100
• Sredaran Nair 04011381520191

ANGGOTA KELOMPOK B7
• SKENARIO
• KLARIFIKASI ISTILAH
• SINTESIS
• TEMPLATE
• KERANGKA KONSEP
• KESIMPULAN

OUTLINE
• Mrs. Helen, 19-year old pregnant woman G1P0A0 38- weeks pregnancy, was brought by her husband to the polyclinic
RSUD Lahat to ANC. She has been complaining of headache, epigastric pain, vomitting and visual blurring for the last 2
days. Patient also complain of uterine contraction since 12 hours ago, also complain of bloody show, but did not complain
of watery discharge. According to her husband, on her last ANC, 3 days ago the midwife found that her blood pressure was
high, and advice to deliver the baby in the hospital. After that patient was deliver to emergency room for further treatment.
• In the examination findings:
• Upon admission,
• Height = 153 cm; Weight = 76 kg;
• Sense : Compos mentis, GCS : 15
• BP: 180/110 mmHg. HR: 100x/min, RR: 21x/m.
• Pretibial edema

• Obstetric examination:
• Outer examination : Fundal height 33 cm, cephalic presentation, contraction 4x/10’/40” FHR: 120x/min, EFW : 3100g
• Vaginal toucher : Potio was tender, effacement 100%, dilatation 7cm, vertex presentation, amniotic fluid (+), HII, transverse
occiput.
• Lab: Hb 10,2 g/dL; PLT :180.320/mm3, WBC : 9.600/mm3 and she had 4+ protein on urine, cylinder (-), LDH: 982g/dl,
Ureum: 22mg/dl, Creatinin: 0,51 mg/dl, SGOT: 99 mg/dl, SGPT: 77 mg/dl, Uric acid: 8,23 mg/dl.

• In emergency room patient was plan for stabilization, patient was in bedrest position. But 2 minute after transfer to
emergency room, patient having convulsion about 2 minute. And after that, patient underwent decrease of consciousness
with GCS 13.

• Examination findings
• Sense : decrease of consciousness, GCS : 13
• BP: 170/110 mmHg, HR: 123x/min, RR: 28x/m.

• Obstetric examination:
• Outer examination : Fundal height 33 cm, cephalic presentation, contraction 4x/10’/40” FHR: 115x/min, EFW : 3100g
• Vaginal toucher : Potio was tender, effacement 100%, dilatation 7cm, vertex presentation, amniotic fluid (+), HII, transverse
occiput.

SKENARIO
• G1P0A0
• Contraction 4x/10’/40”
• HII
• Vertex presentation
• Convulsion
• Effacement

KLARIFIKASI ISTILAH
SINTESIS
1. Mrs. Helen, ( 19) G1P0A0 38-weeks
Last 2 days : Headache, epigastric pain, vomitting and visual
blurring
12 hours ago : uterine contraction, bloody show, but did not
complain of watery discharge
3 days ago : Midwife found that her BP was high
 Defective Impairs
Narrow spiral
trophoblastic placental blood
arteriolar luman
invasion flow

Systemic Diminished
Produksi
inflammatory disfungsi perfusion &
oksidan (radikal
response endotel hypoxic
hidroksil)
environment

Headache
Vasokontriksi Sistemik Epigastric pain
Vomitting
Visual blurring
2. In the examination findings :
2. In emergency room patient was plan for stabilization, patient was in
bedrest position. But 2 minute after transfer to emergency room, patient
having convulsion about 2 minute. And after that, patient underwent
decrease of consciousness with GCS 13.
TEMPLATE
• Differential Diagnose
• Etiologi
• Epidemiologi
• Faktor Risiko
• Tatalaksana
• KIE dan pencegahan
• Komplikasi
• Prognosis
• SKDI
1. Differential Diagnosis
• Hipertensi Essensial
• Epilepsi
• Meningitis
• Ensefalitis
• Cerebral Hemmorhage
2. Etiologi
• Implantasi plasenta disertai invasi trofoblastik abnormal
pada pembuluh a.spiralis
• Toleransi imunologis yang bersifat maladaptif di antara
jaringan maternal, paternal (plasental), dan fetal.
• Maladaptasi maternal terhadap perubahan kardiovaskular
atau inflamatorik yang terjadi pada keharnilan normal
• Faktor-faktor genetik, termasuk gen predisposisi yang
diwariskan, serta pengaruh epigenetik.
3. Epidemiologi

• Prevalensi eklampsia di negara maju 1,3% - 6%

sedangkan di negara berkembang adalah 1,8% - 18%.
• Insiden preeklampsia di Indonesia adalah 128.273/tahun
atau sekitar 5,3%.
4. Faktor Risiko
• Maternal age & parity:
• Young, nulliparous  preeclampsia
• Older  superimposed preeclampsia
• Obesity
• Multifetal gestation
• Hyperhomocysteinemia
• Metabolic syndrome
• History of preeclampsia
5. Tatalaksana
A. Anti-convulsant
• MgSO4 is recommended as 1st line eclampsia treatment
• RCOG guideline:
• Loading dose: 4 g dalam larutan 20 ml(20%) IV / 5-10 minutes
• Maintenance: Tiap 4 jam diberikan 4g IM, bila tidak ada
kontraindikasi (24 Jam terakhir/Pasca Persalinan)
• 2 g bolus IV if convulsion re occur
• Monitor urine output, patella reflex, RR, O2 saturation
B. ANTI HYPERTENSIVE
 Recommended for:
 BP systolic > 160 mmHg or diastolic > 110 mmHg
 BP target:
 Systolic < 160 mmHg and diastolic < 110 mmHg
 1st choice anti hypertensive:
 Short-acting oral nifedipine (10 mg tablet/15-30 minutes max dose 30 mg)
 Other alternative: methyldopa
 250-500 mg per oral 2-3x/day, max dose 3 g/day
 250-500 mg/6 hrs IV, max dose 1 g/6 hrs for crisis HT
• Pengobatan Obstetrik :
1) Semua kehamilan dengan eklamsia hares diakhiri tanpa memandang
umur kehamilan dan keadaan janin.

2) Terminasi kehamilan.
• Sikap dasar : Bila sudah terjadi "stabilisasi" (pemulihan)
hemodinamika dan metabolisme ibu, yaitu 4 — 8 jam setelah salah
satu atau lebih keadaan di bawah ini :
• setelah pemberian obat anti kejang terakhir.
• setelah kejang terakhir.
• setelah pemberian obat-obat anti hipertensi terakhir. penderita mulai
sadar (responsif dan orientasi).
3) Bila anak hidup, SC dapat dipertimbangkan.
5. Komplikasi
• Kerusakan neurologis permanen dari kejang rekuren atau
intracranial bleeding
• Renal insufficiency dan acute renal failure
• IUGR, abruptio placentae, oligohidramnion
• Kerusakan hepar
• Hematologic compromise edan DIC
• Peningkatan risiko terjadinya recurrent
preeklampsia/eclampsia dengan subsequent pregnancy
• Kematian maternal dan fetal
6. Prognosis
• Untuk eklampsia, prognosisnya ditentukan dengan kriteria Eden:
• Koma yang lama (prolonged coma)
• Nadi diatas 120x/menit
• Suhu 39.4oC atau lebih
• Tekanan darah diatas 200 mmHg
• Konvulsi lebih dari 10x
• Proteinuria 10gr atau lebih
• Tidak ada edema, edema menghilang
• Bila tidak ada atau hanya satu kriteria di atas, eklampsia masuk ke
kelas ringan; bila dijumpai 2 atau lebih, termasuk eklmapsia kelas
berat dan prognosis akan lebih buruk.
7. SKDI : 3B
KERANGKA KONSEP
 Ny. Helen 19 tahun G1P0A0 hamil 38 minggu dengan
eklampsia antepartum kala I fase aktif dan Partial HELLP
Syndrome janin tunggal hidup presentasi kepala.

KESIMPULAN