pre eklampsia emergency
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Emergency NursingTRANSCRIPT
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Pre/eklampsia emergencyNs. wijaya
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Munculnya hipertensi sekurang2nya pengukuran TD 140/90 mmHg (diukur dalam 2 kali pengukuran berbeda rentang 4 jam)
Munculnya sekurang2nya 300 mg protein urine dalam 24 jam atau postif 2 dg urine dipstik
Kemunculan tersebut pada kehamilan lebih dari 20 minggu dimana sebelumnya TD dalam batas normal dan hilang setelah 6 minggu postpartum
Edema sering ditemukan, tapi bukan merupakan gejala klinis
Definisi
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Faktor Resiko Kehamilan usia muda Nulliparity : 85% PE terjadi pada
primigravida Peningkatan jaringan plasenta thp usia
kehamila : Mola hidatidosa, kehamilan kembar
Riwayat keluarga dg pre -eclampsia Diabetes mellitus Penyakit ginjal Kelainan koromosompada fetus (eg,
trisomy).
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mild severeSBP <=150mmHg >=160mmHgDBP <=100mmHg >=100mmHgproteinuria >300mg in 24 hours >5000mg in 24
hourheadache absent presentVisual disturbance
absent present
Upper abdominal pain
absent present
oliguria absent Present <500ml/24hr
seizures absent Present in eclampsia
Serum Creatinine level
Normal to mildly ↑ <=1.0mg/dl
Abnormal, >=1.0mg/dl
AST Normal to mildly ↑<=70U/L
elevated >=70U/L
Tingkat Keparahan PE
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Tingkat Keparahan PEmild severe
bilirubin Normal to mildly ↑, <=1.2mg/dl
>=1.2mg/dl
urate Normal to mildly ↑, <=6mg/dl
>=6mg/dl
LDH Normal to mildly ↑, <600U/dl
>600U/dl
Platelet count Normal to mildly ↓, >100,000cells/mm3
<100,000cells/mm3
Pulmonary edema absent presentFetal growth restriction
absent present
oligohydraminos absent present
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Vasospasm theory : •Vasospasms → vasoconstriction → resistance → arterial BP•Eclampsia: Cerebral arterial vasospasm → cerebral edema or infarction and/or cerebral hemorrhage
Patofisiologi
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PatofisiologiDefective trophoplast invasion hypoperfusi
placenta release factors (growth factors, Cytokines)
Aktivasi vascular endothelial cell.• Vasospasm hypertension• Endothelial cell damage oedema,
hemoconcentration• Kidneys, glomeruloendotheliosis
proteinuria,reduced uric excretion dan oliguria.
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• Liver, peningkatan enzim liver, hemorrhage, infarction, liver rupture & epigastric pain.• Darah thrombocytopenia, DIC, HELLP syndrome.• Placental vasospasm placental infarction,placental abruptio & penurunan uteroplacental perfusion IUGR.• CNS vasospasm & oedema headache,
visual symptons(blurred vision, spots,
scotoma) hyperreflexia and convulsions.
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Komplikasi (fetal)
• Intrauterine growth retardation• Premature delivery• Abruptio placentae• Fetal distress/fetal demise
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Komplikasi (maternal)• Disfungsi kardiovascular (cardiac failure,
hipertensi)• Disfungsi Renal (oliguria, penurunan
GFR, peningkatan creatinine)• Disfungsin Respiratory (ARDS,
pulmonary edema)• Disfunsi Hepatic (Peningkatan liver
enzymes, subcapsular hematoma, HELLP syndrome)
• Disfungsi Cerebral (encephalopathy, ischemia, infarction, hemorrhage, edema, eclampsia)
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Manajemen dasar• Meminta pertolongan• ABC• Kontrol bila terjadi kejang• Kontrol tekanan darah• Konsyl darurat O&G unk
persalinan• ICU & Neonatal ICU
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Airway, Breathing and CirculationA – B – C
• Amankan jalan nafas • Berbaring pada posisi kiri
lateral• Pertahankan O2 aliran
tinggi,• IVF resuscitation, cek H’stix• Cardiac monitoring• Urinary catheterization :
monitoring urine output & protein
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Goal: •SBP 140-150mmHg, •DBP 90-100mmHg
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Eclampsia
Adalah kondisi mengancam kehidupan sebagai komplikasi dari eklampsi.Didefinisikan sebagai kejang tonic dan klonic pada wanita hamil dimana tidak terdapat penyebab neurolgis dan metabolik.Merupakan kegawatan obstetricDapat terjadi antenatal, intrapartum, postpartum(setelah persalinan 24-48jam)
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Management eklampsiaABCKontrol kejang
MgSO4Diazepam
Kontro tekanan darahHydralazineLabetolol
Cairancrystalloid 1-2ml/kg/jm dengan monitoring urine output
Persalinan segera fetus dalam 4 jam setelah maternal stabilizationMgSO4 terus diberikan dalam 24 hr setelah persalinan atau, jika postpartum, 24 jam setelah kejang terakhir,