kuliah kbk holistik (dr. f. wagey)
TRANSCRIPT
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Penyakit yang menyertai dalamkehamilan
Freddy W WageyBag./SMF Oibstetri dan GinekologiFK Unsrat/RSUP Prof. RD Kandouw
Manado
Penyakit yang menyertai dalam
kehamilan
Freddy W WageyBag./SMF Obstetri dan GinekologiFK Unsrat/RSUP Prof. RD Kandouw
Manado
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Penyakit yang menyertai dalam
kehamilan1. Penyakit traktus urinarius2. Penyakit traktus Respiratorius3. Penyakit jantung dalam kehamilan4. Hipertensi dalam kehamilan
5. Diabetes mellitus dalam kehamilan6. Penyakit lain
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Penyakit traktus urinarius
Anatomic Changes in the Kidney DuringPregnancy
Increased kidney size ( 1 cm) Increased renal blood flow Increased glomerular filtration rate
Dilation of urinary tract
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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%
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INTERRELATIONSHIPS BETWEENPREGNANCY 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
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MANAGEMENT OF CHRONIC RENALDISEASE DURING PREGNANCY
Preconception counseling Multidisciplinary approach
Frequent monitoring of blood pressure (every1 2 wk) and renal function (every mo) Balanced diet (moderate sodium, protein)
Maintain blood pressure at 120 140/80 90mm Hg Monitor for signs of preeclampsia
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1. Hypertension related to pregnancy2. Hypertension returns to baseline
by 6 weeks postpartum3. PIH, by definition, after 20 weeks*
gestation
(* exception = GTD)
Pregnancy Induced Hypertension(PIH)
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Free Powerpoint Templates Page 11
Definitions
1. Hypertension2. Edema3. Proteinuria
http://www.powerpointstyles.com/http://www.powerpointstyles.com/ -
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Page 12
Hypertension
SBP rise of 30 mm Hg or DBP rise of 15 mm Hgis probably not significant provided sustained BPis
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Proteinuria
1. Greater than 300 mg in 24 hour period2. Greater than 100 mg/dl dipstick
(sustainable)
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Edema Difficult Definition(80 + % of normal gravidasexhibit edema)
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Pregnancy InducedHypertensi
1. Preeclampsia
2. Eclampsia3. Late transient HT
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Pregnancy Induced Hypertensi
Preeclampsia = PIH with proteinuria
Eclampsia = PIH with seizure activity
Late transient HTN = HTN alone without
otherapparent organ involvement
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Preeclampsia:
A. MildB. Severe
1. HELLP Syndrome
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Severe Preeclampsia BP > 160/110 mmHg Proteinuria > 5 gm/24hr Azotemia/oliguria (< 500mL/24hr)
Microangiopathic hemolysis Thrombocytopenia End organ symptoms:
1. CNS 2. Visual 3. Hepatic Intrauterine growth delay
oli oh dramnios?
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Etiology of PIH
1. Etiology still uncertain2. Mediator responses may be effect orcausal (??!!)
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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
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Diabetes Mellitus pada Kehamilan
DM pada kehamilan adalah intoleransikarbohidrat ringan (toleransi glukosaterganggu) maupun berat (DM), kehamilanberlangsung
1,9-3,6% kasus DM dlm kehamilan
http://keluargacemara.com/kesehatan/kehamilan/diabetes-mellitus-pada-kehamilan.htmlhttp://keluargacemara.com/kesehatan/kehamilan/diabetes-mellitus-pada-kehamilan.html -
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Diabetes Mellitus pada Kehamilan
Faktor risiko : pernah melahirkan bayi 4000 g, preeklamsia,
IUFD, Cacad bawaan, Usia ibu > 30 thn,riwayat DM dlm keluarga, pernah DMsebelumnya
40-60 % ibu DM pada kehamilan tetap DMstlh persalinan
http://keluargacemara.com/kesehatan/kehamilan/diabetes-mellitus-pada-kehamilan.htmlhttp://keluargacemara.com/kesehatan/kehamilan/diabetes-mellitus-pada-kehamilan.html -
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