Pre eklampsia

Pendahuluan

Sekitar delapan juta perempuan/tahun mengalami komplikasi

kehamilan dan lebih dari setengah juta diantaranya meninggal
dunia, dimana 99% terjadi di Negara berkembang.

Angka kematian akibat komplikasi kehamilan dan persalinan di

Negara maju yaitu 1 dari 5000 perempuan, dimana angka ini
jauh lebih rendah dibandingkan di Negara berkembang, yaitu
1 dari 11 perempuan meninggal akibat komplikasi kehamilan
dan persalinan.
Tiga penyebab utama kematian ibu adalah perdarahan
(30%), hipertensi dalam kehamilan (25%), dan infeksi (12%)

WHO memperkirakan kasus preeklampsia tujuh kali lebih

tinggi di negara berkembang daripada di negara maju.

Prevalensi preeklampsia di Negara maju adalah 1,3% - 6%,

sedangkan di Negara berkembang adalah 1,8% - 18%

Insiden preeklampsia di Indonesia sendiri adalah

128.273/tahun atau sekitar 5,3%
 Klasifikasi
Hypertension in pregnancy can be classified into four categories:
• Preeclampsia/eclampsia: Hypertension in association with thrombocytopenia
elevated liver function, new development of renal insufficiency, pulmonary edema
or new-onset cerebral or visual disturbances. This may be further classified as
preeclampsia with severe features or preeclampsia without severe features.
Eclampsia refers to the occurrence of one or more generalized convulsions in the
setting of preeclampsia and in the absence of other neurologic conditions. HELLP
syndrome is a subset of preeclampsia.
• Chronic hypertension: Hypertension that predates pregnancy
• Chronic hypertension with superimposed preeclampsia: Chronic hypertension in
association with preeclampsia or eclampsia. This may be further classified as
chronic hypertension with superimposed preeclampsia with severe features or
chronic hypertension with superimposed preeclampsia without severe features.
• Gestational hypertension: Blood pressure elevation after 20 weeks in the absence
of proteinuria or the aforementioned systemic findings
Algoritme
 Definisi

Preeklampsia merupakan kondisi spesifik pada kehamilan

yang ditandai dengan adanya disfungsi plasenta dan respon
maternal terhadap adanya inflamasi sistemik dengan
aktivasi endotel dan koagulasi.

Diagnosis preeklampsia ditegakkan berdasarkan adanya

hipertensi spesifik yang disebabkan kehamilan disertai
dengan gangguan sistem organ lainnya pada usia kehamilan
diatas 20 minggu.
 Patofisiologi

Patofisiologi pre eklampsia masih tidak diketahui

• Immune mechanism (rejection phenomenon, insufficient
blocking Ab)
• Injury of vascular endothelium----disruption of the equilibrium
between vasoconstriction and vasodilatation, imbalance
between PGI (Prostaglandin) and TXA (Tromboxan)
• Compromised placenta profusion Genetic factor
• Dietary factors: nutrition deficiency
• Insulin resistance
• Increase CNS irritability
Faktor resiko
Diagnosis
Tatalaksana
 Waktu Persalinan
Preeclampsia without severe features:
• At diagnosis goal of 37 0/7 weeks
Preeclampsia with severe features:
• At diagnosis goal of 34 0/7 weeks
HELLP syndrome
• At diagnosis goal of 34 0/7 weeks
• At diagnosis prior to gestational age of fetal viability
• At diagnosis in the presence of disseminated intravascular coagulation, liver infarction or hemorrhage, renal failure, placental
abruption or nonreassuring fetal status.
• Consider delay of delivery for 24-48 hours if maternal and fetal conditions remain stable to complete a course of
corticosteroids for fetal benefits from the gestational age of fetal viability to 33 6/7 weeks. Delivery after completion of
corticosteroids
Chronic hypertension on no medication
• 38 0/7-39 6/7 weeks of gestation
Chronic hypertension on medication
• 37 0/7-39 and 6/7 weeks of gestation
Chronic hypertension with superimposed preeclampsia with severe features
• At diagnosis after 34 0/7 weeks
Chronic hypertension with superimposed preeclampsia without severe features
• At diagnosis after 37 0/7 weeks
Gestational hypertension:
• 37 0/7-38 6/7 weeks of gestation
• Strongly consider delivery after 37 0/7 weeks
Terima Kasih