Hiperemesis Gravidarum i
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Transcript of Hiperemesis Gravidarum i
7/25/2019 Hiperemesis Gravidarum i
http://slidepdf.com/reader/full/hiperemesis-gravidarum-i 1/20
1
HIPEREMESIS GRAVIDARUM
OLEH
Dr. FERDINAL FERRY, SpOG(K)RSUD PARIAMAN
7/25/2019 Hiperemesis Gravidarum i
http://slidepdf.com/reader/full/hiperemesis-gravidarum-i 2/20
Etiologi
• Belum diketahui secara pasti
Faktr predispsisi!
1" Primi#ra$ida% mla hidatidsa da&kehamila& #a&da. Frekue&si 'a&# ti&##i pada mla hidatidsa da& kehamila& #a&da
me&im(ulka& du#aa& (ah)a *aktrhrm& meme#a&# pera&a& kare&a padakedua keadaa& terse(ut hrm& khri&ik#&adtrpi& di(e&tuk (erle(iha&"
+
7/25/2019 Hiperemesis Gravidarum i
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Etiologi
Faktr predispsisi!
+" Masuk&'a $ili khrialis dalam sirkulasi
mater&al% peru(aha& meta(lik% resiste&si
'a&# me&uru& dari pihak i(u"
," Aler#i - resp& dari .ari&#a& i(u
terhadap a&ak
/" Faktr psikl#ik
,
7/25/2019 Hiperemesis Gravidarum i
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Patoi!iologi
• Mual da& mu&tah
– Aki(at dari me&i&#kat&'a kadar estr#e&%
kare&a keluha& i&i ter.adi pada trimester pertama"
– Mu&#ki& (erasal dari sistem sara* pusat aki(at
(erkura&#&'a pe&#s&#a& lam(u&#"
• Bila ter.adi terus0me&erus - dehidrasi da&
im(ala&s elektrlit de&#a& alkalsis
hipklremik"/
7/25/2019 Hiperemesis Gravidarum i
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Patofisiologi
cada&#a& kar(hidrat da& lemak ha(is terpakai
ksidasi lemak 'a&# tidak sempur&a
tertim(u&&'a asam aset&0asetik% asam
hidrksi(utirik da& aset& dalam darah
ketsis
2
7/25/2019 Hiperemesis Gravidarum i
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Patofisiologi
kekura&#a& caira& 'a&#
dimi&um
kehila&#a& caira& kare&a
mu&tah
Dehidrasi
caira& ekstraseluler da&
plasma (erkura&#
&atrium da& khlridadarah turu&
hemk&se&trasi
alira& darah ke .ari&#a& (erkura&#
3at maka&a& da& ksi#e& ke
.ari&#a& (erkura
7/25/2019 Hiperemesis Gravidarum i
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Patofisiologi
• 5ekura&#a& kalium se(a#ai aki(at dari
mu&tah da& (ertam(ah&'a ekskresi le)at
#i&.al - me&am(ah *rekue&si mu&tah0mu&tah '# le(ih (a&'ak - dpt merusak hati"
• Dapat .u#a ter.adi r(eka& pada selaputle&dir es*a#us da& lam(u&# 6Si&drm
Mallr'07eiss8 - perdaraha&
#astri&testi&al" 9
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G"#ala Da$ %a$&a
M"$'r't "rat ri$ga$$a g"#ala &iagi *"&ala+ ti$g*ata$-
%i$g*ata$ I• M'$ta t"r'!/+"$"r'!• L"+a• Na!' +a*a$ 0 1 2 • 33 0• N"ri "piga!tri'+•
Na&i 4 (!"*itar 566 p"r +"$it)• %D !i!toli* 0• %'rgor *'lit +"$g'ra$g• Li&a +"$g"ri$g• Mata 7"*'$g
:
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Gejala Dan Tanda
%i$g*at II• L"i l"+a &a$ apati!• %'rgor *'lit l"i +"$g'ra$g• Li&a +"$g"ri$g &a$ ta+pa* *otor• Na&i *"7il &a$ 7"pat• S'' *a&a$g/*a&a$g $ai* • Mata !"&i*it i*t"ri*• 3"rat a&a$ 0 &a$ +ata 7"*'$g,• %D 0, "+o*o$!"$tra!i, olig'ria &a$ *o$!tipa!i.• Napa! a' a!"to$ &a$ &apat p'la &it"+'*a$
&ala+ *"$7i$g.
;
7/25/2019 Hiperemesis Gravidarum i
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Gejala Dan Tanda
%i$g*at III• K"a&aa$ '+'+ l"i para• M'$ta "r"$ti• K"!a&ara$ +"$'r'$ &ari !o+$ol"$ !a+pai *o+a• Na&i *"7il &a$ 7"pat, !'' 4 &a$ %D 0.• Ko+pli*a!i atal pa&a !'!'$a$ !ara 8 "$!"alopati
9"r$i7*", &"$ga$ g"#ala $i!tag+'!, &iplopia &a$p"r'aa$ +"$tal.
•
K"a&aa$ i$i a&ala a*iat !a$gat *"*'ra$ga$ :at+a*a$a$, t"r+a!'* ;ita+i$ 3 *o+pl"*.• %i+'l$a i*t"r'! +"$'$#'**a$ a&a$a paa ati.
1<
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11
G"#ala &a$ %a$&a
G"#ala Gra&" I Gra&" II Gra&" III
M'$ta << << <1/
KU L"+a < L"+a <<1apati L"+a <<<1
*!&r /7o+a
%'rgor / // ///
Na&i1%D =pt1t'r'$ K"7il1t'r'$ K"7il1t'r'$
PE Li&a *rg,
+ata 7*g
H"+o*o$!"$tra!i
Olig'ri,a' a!"to$
E$!"alopati
9"r$i7*"
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Diag$o!i!
• Ada&'a kehamila& muda
• Mu&tah 'a&# terus0me&erus
• Namu& demikia& harus dipikirka&
kehamila& muda de&#a& pe&'akit
piel&e*ritis% hepatitis% ulkus $e&trikuli da&
tumr sere(ri 'a&# dapat pula mem(erika&#e.ala mu&tah"
1+
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P"$atala*!a$aa$
• A!'a$ a$t" $atal
– M"+"ri*a$ p"$"ra$ga$ t"$ta$g *"a+ila$ &a$
p"r!ali$a$ !"agai !'at' pro!"! a$g i!iologi*,
– M"+"ri*a$ *"a*i$a$ a>a +'al &a$ *a&a$g/*a&a$g +'$ta +"r'pa*a$ g"#ala g i!iologi* p&
*"a+ila$ +'&a &a$ a*a$ ila$g !tl *"a+ila$ ?
'la$,
–Ma*a$ &"$ga$ #'+la *"7il, t"tapi l"i !"ri$g .
– M"$gi$&ari +a*a$a$ "r+i$a* &a$ "ra' l"+a*.
– D""*a!i a$g t"rat'r
– Ma*a$ +a*a$a$ a$g a$a* +"$ga$&'$g g'la .
1,
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Penatalaksanaan
• Islasi.
– Ka+ar a$g t"$a$g 7"ra &a$ p"r"&ara$
'&ara a$g ai* – Ha$a &o*t"r &a$ p"ra>at a$g ol"
*"l'ar +a!'* *a+ar !a+pai +'$ta
"r"$ti &a$ pa!i"$ +a' +a*a$.
– 3ata!i p"$g'$#'$g
• Stop a!'pa$ p"r oral @?/? #a+.
1/
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Penatalaksanaan
• M"&i*a+"$to!a
– S"&ati;a-
• p"$oarital 6 +g IM @/ *ali p"r ari ata'• 7lorpro+a:i$" @B/B6 +g1r IM ata'
• &ia:"pa+ B +g @/ *ali p"r ari IM.
– Vita+i$-
• Vit 35, 3@ &a$ 3C +a!i$g/+a!i$g B6/566
+g1r1i$'!,
• Vit 35@ @66 +7g1r1i$'!,
• Vit = @661r1i$'!.12
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Penatalaksanaan• M"&i*a+"$to!a
– A$tii!ta+i$
– A$ti"+"ti* -
• pro+"ta:i$" (a;opr"g) @/ +g1r
• pro7lorp"ra:i$" (!ti+"til) +g1r
• +"&ia+"r 3C 51 r
/A$ta!i&a -• a7i&ri$" 5 ta1r
• +la$ta 5 ta1r
•
+ag$a+ 5 ta1r. 14
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Penatalaksanaan
• =aira$ par"$t"ral
– I$'! gl'*o!a 56 ata' B - RL @ - 5, ?6 t"t"! p"r
+"$it.
– 3ila a&a *"*'ra$ga$ prot"i$, &apat &i"ri*a$ p'la
a!a+ a+i$o !"7ara i$tra ;"$a
• P"+"ri*!aa$
– Prot"i$, a!"to$, *lori&a &a$ ilir'i$ 'ri$" p"rari
– S'' &a$ $a&i &ip"ri*!a !"tiap ? #a+ &a$ t"*a$a$
&ara *ali !"ari.
– P"+"ri*!aa$ "+ato*rit pa&a p"r+'laa$ &a$
!"t"r'!$a +"$'r't *"p"rl'a$.
19
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Penatalaksanaan
• Bila selama +/ .am pe&derita tidak
mu&tah da& 5U mem(aik dapat dic(a
u&tuk di(erika& mi&uma& lalu maka&a&'a&# tidak cair"
• Pe&#he&tia& kehamila&
– Bila 5U tidak mem(aik=mem(uruk% misal&'ater.adi delirium% ke(utaa&% takikardi% ikterus%
a&uria da& perdaraha& - akhiri kehamila&"
1:
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Prog$o!i!
• De&#a& pe&a&#a&a& 'a&# (aik pr#&sis
hiperemesis #ra$idarum sa&#at memuaska&"
1;