2 Gest Hypertension WorkShop rev b ind1--.ppt

ilmiah

1. Gestational Hypertension International
Work Shop
Hipertensi dalam Kehamilan

2. Gestational Hypertension International
KASUS 1
Seorangibu,23tahun,G1hamil35weeksdatangdirujuk
bidandenganketeranganhipertensidanpenglihatan
buramsejak4jamyanglalu.
PF:TD170/110mmHgNadi96x/m
TBJ2200g BJJ150dpm
Lab:Hb14Ht45Tr170.000Albumin3,0
SGPT23SGOT21LDH650Asamurat7

3. Gestational Hypertension International
Diagnosis yang anda tegakkan pada pasien ?
Pertanyaan 1

4. Gestational Hypertension International
Pertanyaan 1
Diagnosis yang anda tegakkan pada pasien adalah :
a.Sindroma HELLP
b.Hipertensi dalam kehamilan
c.Eklamsia imminen
d.Buta kortikal pada preeklamsia berat
e.……..

5. Gestational Hypertension International
Pertanyaan 2
Tatalaksana awal yang anda lakukan :
a.Pemberian antihipertensi
b.N-acetyl cysteine
c.Acetylsalicylic acid
d.MgSO4
e.……….

6. Gestational Hypertension International
Pertanyaan 3
Komplikasi yang mungkin terjadi adalah :
a.Solusio plasenta
b.Eklamsia
d.Preeklamsia superimpos
e.Kebutaan menetap
f.………

7. Gestational Hypertension International
Pertanyaan 4
Apa tatalaksana selanjutnya yang anda pilih?
a.Konservatif sampai aterm
b.Akhiri kehamilan

8. Gestational Hypertension International
KASUS 2
Seorangibu,20tahun,G1hamil36minggudatang
kekamarbersalindengankeluhanmules.
TD140/100mmHg Kontraksi2x/10mnt
TBJ2400g CTGkategori1
Periksadalam:portiotipis,dilatasiserviks1cm,
kepaladiHodgeII.

9. Gestational Hypertension International
KASUS 2
Laboratoriumdarah:
Hb13Ht42Tr180.000Albumin3,0
SGPT25SGOT20LDH600Asamurat7

10. Gestational Hypertension International
Pertanyaan 1
Tatalaksanaawalyang andalakukan:
a.Pemberianantihipertensi
b.PemberianMgSO4
c.Pematanganparu
d.Observasi
e.Tokolitik

11. Gestational Hypertension International
Pertanyaan 2
Saatobservasipasienmengeluhsakitkepala,
kemudiankejangtonik-klonik.Apatatalaksana
yangandadiberikan:
a. Magnesium sulfat 2 g
b. Magnesium sulfat 4 g
c. Diazepam
d. Fenitoin

12. Gestational Hypertension International
Pertanyaan 3
Apa tatalaksana anda selanjutnya?
a.SC cito
b.Partus pervaginam
c.Lanjutkan observasi
d.………

13. Gestational Hypertension International
Kasus 3
Seorangibu,25tahun,G1hamil35minggudatangke
kamarbersalindengankeluhansesaknapassejak,mules
dankeluarcairandarikemaluan.
PF:TD160/110mmHgFreknapas30x/menit
Nadi110 S36,8
0
C Sat87%
Ronki halus di kedua paru
TBJ 2000 g BJJ 160 dpm
Kontraksi reguler

14. Gestational Hypertension International
Pertanyaan 1
Perkiraan diagnosis menurut anda ?
a.Preeklamsia
b.Preeklamsia disertai edema paru
c.Hipertensi dengan pneumonia
d. Congestive heart failure

15. Gestational Hypertension International
Pertanyaan 2
Apa tatalaksana awal anda pada pasien?
a.…………..
b.…………..
c.…………..
d.…………..

16. Gestational Hypertension International
Pertanyaan 3
Pada pemeriksaan dalam didapatkan pembukaan 9 cm,
selaput ketuban (+), kepala di H3+
a.Apa metode persalinan yang akan anda lakukan?
………..
b. Persiapan apa yang anda butuhkan ?
………

17. Gestational Hypertension International
KASUS 4
Seorang ibu, 18 th, dirujuk oleh PKM
dengan keterangan G1 hamil 34 minggu
hipertensi.
PF :
TD 150/100 mmHg Nadi 100 x/m
Frek napas 24 x/m S 36,5 C
Sat 98 %

18. Gestational Hypertension International
Kasus 4
USG : TBJ 1800 g ICA 8 cm
CTG kategori 2
Hasil lab darah di RS :
Hb 10 Ht 34 Tr 30.000 L 7000
SGPT 400 SGOT 320 LDH 700
Asam urat 9

19. Gestational Hypertension International
Pertanyaan 1
Apa masalah yang ada pada pasien ?
a.………..
b.………..
c.………..

20. Gestational Hypertension International
Pertanyaan 2
Apa rencana tatalaksana anda ?
a.Akhiri kehamilan
b.Konservatif

21. Gestational Hypertension International
Pertanyaan 2
Menurutanda,persiapanapayangdibutuhkan
jikaakanmelakukanpengakhirankehamilan?
a.………
b.………
c.………
d.………
e.………

22. Gestational Hypertension International
Pertanyaan 3
Menurut anda, apakah pasien harus
dirujuk ?
Apa alasan anda merujuk ?

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24. Gestational Hypertension International
Two hours ago, a 25 year-old woman was hospitalized at
33 weeks gestation with gestational hypertension. She is
complaining of headache and visual disturbance. Her
blood pressure is 165/115, urine is 3+ for protein.
List three(3) important components of management.
Answer:

25. Gestational Hypertension International
You are asked to see a 20 year-old patient who is in for
gestational hypertension with adverse conditions at 34
weeks.
She has been receiving 2 gm/ hrof MgSO4 for the past 10
hours.
When you arrive, she is sitting up in bed breathing with her
accessory muscles and receiving 100% oxygen at 7 L/min.
Vital signs: RR16, PR 110, Temperature 36.7,
BP of 140/90. Areflexic.
What are the first two(2) steps in the immediate
management of this patient?
Answer:

26. Gestational Hypertension International
A 25 year old woman presents at 34 weeks with mild
gestational hypertension. She has no other
complications. Name two(2) medications that can be
safely used in pregnancy for lowering and maintaining
blood pressure.

27. Gestational Hypertension International
A 25-year-old G1 woman at 38 weeks presents with right
upper quadrant pain. Her blood pressure is 170/105 and her
urine shows 3+ for protein.
What are your initial investigations in emergency?
What is your management plan?

28. Gestational Hypertension International
8/1/2024
Magnesium sulphate
6 g (15 ml of MgSO4 40%)
In 500 ml Ringer Lactate/
Dextrose 5%

29. Gestational Hypertension International
Kadar Magnesium dalam serum pada penderita
Preeklampsi
Kadar Mg-serum pada
regimen infus 3 gram/jam vs 1
gram/jam
Sumber : Hudono L. 1989

30. Gestational Hypertension International
Kadar Mg serum pada regimen IV dan IM
Pemberian drip IV lebih stabil
dibandingkan dengan
pemberian IM

31. Gestational Hypertension International
Mg conc (mmol/L) Effects
0.8 -1.0 Normal plasma level
1.7 -3.5 Therapeutic range
2.5-5.0 ECG changes (P-Q interval prolongation, widen QRS complex)
4.0 -5.0 Reduction in deep tendon reflexes
> 5.0 Loss of deep tendon reflexes
> 7.5 Sinoatrial and atrioventricular blockade.
Respiratory paralysis and CNS depression
> 12 Cardiac arrest
Magnesium Level Monitoring

32. Gestational Hypertension International
Magnesium Level Monitoring
Mg conc (mmol/L)
Effects
0.8 -1.0
Normal plasma level
1.7-3.5
Therapeutic range
2.5-5.0ECG changes (P-Q interval prolongation, widen QRS complex)4.0 -
5.0Reduction in deep tendon reflexes> 5.0Loss of deep tendon reflexes>
7.5Sinoatrial and atrioventricular blockade. Respiratory paralysis and CNS
depression> 12Cardiac arrest

33. Gestational Hypertension International
A 32-year-old G2P1 woman presents for her routine prenatal visit
at 32 weeks gestation. Her BP’s 140/90. In the past, it has been
115/75 to 130/85 throughout the pregnancy. Her weight is 105
kg. What steps do you perform as part of your initial
investigation?
Repeat blood pressure over the next three hours range from
140/90 to 155/95. What is your management plan?

34. Gestational Hypertension International
Assessment of Mother -Clinical
•Blood Pressure
-assess severity
-consistency in measuring
-relationship of high BP to CVA not seizure
•Central Nervous System
-presence and severity of headache
-vision disturbances -blurring, scotomata
-tremulousness, irritability, hyperreflexia, somnolence
-nausea and vomiting

35. Gestational Hypertension International
Assessment of Mother -Clinical
•Hematologic
-edema
-bleeding, petechiae
•Hepatic
-RUQ and epigastric pain
-nausea and vomiting
•Renal
-urine output and colour

36. Gestational Hypertension International
Assessment of Mother -Laboratory
•Hematologic
-hemoglobin, platelets, blood film
-PTT, INR, fibrinogen, FDP
-LDH, uric acid, bilirubin
•Hepatic
-ALT, AST
-(glucose, ammonia to R/O AFLP)
•Renal
-proteinuria
-creatinine, urea, uric acid

37. Gestational Hypertension International
Assessment of Fetus
•Fetal movement
•Fetal heart rate assessment
•Ultrasound for growth
•Biophysical profile
•Amniotic fluid volume
•Doppler flow studies

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