Lapsus Eclamsi

8/17/2019 Lapsus Eclamsi

1/21

LAPORAN KASUS INDIVIDU

ECLAMPSIA POSTPARTUM

FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH MALANGRUMAH SAKIT MUHAMMADIYAH LAMONGAN

Pembimbing:!" M#$%" M&'!#e() S*OG

Di+,+,n O-e% :L,+./&(& In&++&ni A-i&201200101111


2/21

PENDAHULUAN

E3-&m*+i& me!,*&3&n 3&+,+ &3,. *&& *ene!i.&*!ee$-&m*+i& /&ng i+e!.&i eng&n 3e4&ng men/e-,!,% &n3#m&" On+e. .e!4&in/& e3-&m+i& ini &*&. .e!4&i&n.e*&!.,m) in.!&*&!.,m) &n *#+. *&!.,m

E3-&m*+i& *#+. *&!.,m &&-&% e$-&m*+i& /&ng .e!4&i 5 4&m +e.e-&% *!#+e+ 3e-&%i!&n n&m,n 3,!&ng &!i mingg, Sib&i) 20067

An.e*&!.,m

In.!&*&!.,m

P#+.*&!.,m

28


3/21


4/21

RPD : P#+. S? i RSUD 2 mingg, /&ng -&-, 5 =&n 20167 TP: 1@ =&n2016

DM i+&ng3&-) HT i+&ng3&-) HT +e-&m& %&mi- i+&ng3&-R" Ob+ : I" S? ini3&+i *&ngg,- +em*i. &.e!mL&3iB-&3i;;: 9900 g!R) K; : Ti&3 mengg,n&3&n K;R" G/n : Men&!$%e 19 .&%,n) +i3-,+ %&i 25 %&!i) +&&. %&i *e!&!&%&nb&n/&3 C n/e!i CR" AN? : AN? 2> i bi&n

Pemeriksaan Fisik

Ke&&&n Um,m: ;&i3Ke+&&!&n : G?S 6Vi.&- +ign : Te3&n&n D&!&%: 12 mn. S,%, : 9@)9 #? RR : 26>meni.

P!im&!/ S,!e/:A: Un$-e&!) +n#!ing B7 g&!g-ing B7 *#." Ob+.!,$.i#n C7 +*e&3 ,en./ B7;: S*O2 meni.D: G?S 96) -&. BB) P;I i&me.e! 9mm9mm) i+,+ 1 1 LP CC


5/21


6/21

Peme!i3+&&n L&b#!&.#!i,mD&!&% Leng3&* :•Le3#+i. 11)@ 109,L B Ne,.!#*i- @58•Lim*#+i. 1


7/21

Diagnosis•P1001 ATH•E$-&m*+i& *#+. *&!.,m•H/*#3&-emi&•P&*i-eem&

Terai1" in(" RL 100$$2 4&m2" In4" SM m&in.en&n$e 08 10 g! b#3&b#3i ,-&ng *e! 6 4&m g! b#3&9" In4" De>& 9>1 &m* i" &+" Me(en&m&. 9>00 mg *#" E-3&n& .&b 1>1 *#

Monitoring•Vi.&- Sign TD) n&i) +,%,) RR7•Ke4&ng be!,-&ng•P#+. S?: K&-& IV) *e!&!&%&n *e! &gin&m) -,3& #*e!&+iPrognosis•D,bi& & b#n&m


8/21

T&ngg&

-

S,b4e$.ie Ob4e$.ie A++e+men. P-&nning

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TD: 19155 N: @5 T:

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9/21

E3-&m*+i& *#+. *&!.,m &&-&% e$-&m*+i& /&ng .e!4&i 5 4&m +e.e-&% *!#+e+3e-&%i!&n n&m,n 3,!&ng &!i mingg, Sib&i) 20067" Ke4&i&n e3-&m*+i&*#+. *&!.,m &%,-, be-,m i*e!$&/&i &*&. .e!4&i -ebi% &!i 5 4&m +e.e-&%b&/i -&%i!) n&m,n bebe!&*& -&*!#!&n meng3#n!m&+i &&n/& late post-

partum eclampsia ini" P&+ien eng&n e3-&m*+i& *#+. *&!.,m ini memi-i3ige4&-& &n .&n& /&ng +&m& eng&n *!ee$-&m*+i& eng&n m,n$,-n/&3e4&ng"

TIN!AUANPUSTAKA

E3-&m*+i& b&n/&3 .e!4&i *&& .!ime+.e! .e!&3%i! &n +em&3inmening3&. +&&. mene3&.i 3e-&%i!&n" P&& 3&+,+ /&ng 4&!&ng)e3-&m*+i& .e!4&i *&& ,+i& 3e%&mi-&n 3,!&ng &!i 20 mingg," Se3.&!

@8 3e4&ng e3-&m*+i& .e!4&i +ebe-,m me-&%i!3&n) 08 +&&. 5 4&m*e!.&m& +e.e-&% me-&%i!3&n) .e.&*i 3e4&ng 4,g& &*&. .imb,- +e.e-&% 6

E3-&m*+i&

E3-&m*+i&g!&i&!,m

&n.e*&!.,m7

E3-&m*+i&*&!.,i!en.,min.!&*&!.,m7

E3-&m*+i&*,e!*e!&-e

*#+.*&!.,m7)


10/21

.e#!i i+3emi&*-&+en.&)!&i3&- beb&+)&n i+(,ng+i

en#.e-).e#!iin.#-e!&n+iim,n#-#gi3&n.&!& ib, &n 4&nin.e#!i &&*.&+i

3&!i#&+3,-&!

.e#!iinfamasi,

.e#!ie+ien+igii)

.e#!i gene.i3


11/21

Ib, &-&m 5 4&m +e+,&% *e!+&-in&n /&ng menge-,% n/e!i 3e*&-&%eb&.) *eng-i%&.&n 3&b,! &n n/e!i e*ig&!+.i3 *e!-, i$,!ig&i &&n/&

*!ee3-&m*+i be!&. &.&, *!ee3-&m*+i *&+$& *e!+&-in&n

"e#a$a K$inis

Ge!&3&n 3e4&ng bi&+&n/& im,-&i &!i &e!&%m,-,. +eb&g&i ben.,3 3e4&ng i &e!&%

&4&%"

Se-,!,% .,b,% men4&i 3&3, 3&!en& 3#n.!&3+i #.#. /&ngmen/e-,!,%) (&+e ini &*&. be!-&ng+,ng 10 +&m*&i 1 e.i3"

P&& +&&. /&ng be!+&m&&n !&%&ng &3&n .e!b,3& &n .e!.,.,*eng&n 3e!&+

F&+e ini &*&. be!-&ng+,ng +&m*&i +&., meni.) 3em,i&n +e$&!&be!&ng+,! 3#n.!&3+i #.#. men4&i +em&3in -em&% &n 4&!&ng


12/21

• S.&i,m In&+i &&- &.&, &,!#!&7M&.& .e!*&3, &n .e!b,3& .&n*& me-i%&.) 3e-#*&3 m&.& &n .&ng&nbe!ge.&!) 3e*&-& i*&-ing3&n 3e3&n&n &.&, 3i!i" S.&i,m ini be!-&ng+,ng3i!&B3i!& 90 e.i3

• S.&i,m Ke4&ng T#ni3Se-,!,% #.#. b&&n 3&3,) &4&% 3&3,) .&ng&n menggengg&m &n 3&3imembeng3#3 3e&-&mJ *e!n&(&+&n be!%en.i) m,3& m,-&i 3e-i%&.&n+i&n#+i+) -i&% &*&. .e!gigi." S.&i,m ini be!-&ng+,ng 3i!&B3i!& 20B90 e.i3

• S.&i,m Ke4&ng K-#ni3Sem,& #.#. be!3#n.!&3+i be!,-&ngB,-&ng &-&m &3., /&ng $e*&." M,-,..e!b,3& &n men,.,*) 3e-,&! -,&% be!b,+& &n -i&% &*&. .e!igigi." M&.&me-#.#.) m,3& 3e-i%&.&n 3#nge+.i &n +i&n#+i+" Se.e-&% be!-&ng+,ng+e-&m& 1B2 meni. 3e4&ng 3-#ni3 be!%en.i &n *ene!i.& .i&3 +&&!)men&!i3 n&(&+ +e*e!.i meneng3,!"

•

S.&i,m K#m&L&m&n/& 3e.i&3+&&!&n 3#m&7 ini be!-&ng+,ng +e-&m& bebe!&*& meni.+&m*&i be!4&mB4&m" K&&ngB3&&ng &n.&!& 3e+&&!&n .imb,- +e!&ng&nb&!, &n &3%i!n/& ib, .e.&* &-&m 3e&&&n 3#m&" Se-&m& +e!&ng&n.e3&n&n &!&% meninggi) n&i $e*&. &n +,%, n&i3 +&m*&i 00 ?


13/21

Di&gn#+i+ ;&ning

1" E*i-e*+i

P&& &n&mne+i+ *&+ien e*i-e*+i &3&ni&*&.3&n e*i+#e +e!&ng&n +e4&3 +ebe-,m%&mi- &.&, *&& %&mi- m,& .&n*& .&n&*!ee3-&m*+i&"

2" Ke4&ng 3&!en& #b&. &ne+.e+i

A*&bi-& #b&. &ne+.e+i -#3&- i+,n.i33&n3e &-&m

en&) 3e4&ngb&!, .imb,-"9" K#m& 3&!en& +eb&b -&in) +e*e!.ii&be.e+me-i.,+) *e!&!&%&n #.&3) meningi.i+)en+e(&-i.i+)&n -&inB-&in


14/21

T&.&-&3+&n&

• P!in+i* *en&.&-&3+&n&&n *&& e3-&m*+i& memi-i3i *!in+i*+eb&g&in be!i3,.:

• Ob&. &n.i 3e4&ng

– Pembe!i&n MgSO me-&-,i in.!&en& +e$&!& 3#n.in/, +e+,&i

eng&n *enge-#-&&n *!ee3-&m+i be!&. mengg,n&3&n in(,+i#n

*,m*7"• D#+i+ &&- :

g!&m 20 $$ MgSO 208 i-&!,.3&n &-&m 100 $$ !inge! -&3.&.)ibe!i3&n +e-&m& 1B20 meni.7"

• D#+i+ *eme-i%&!&&n :

» g!&m 0 $$ MgSO 208 7 &-&m 00 $$ $&i!&n RL"Dibe!i3&n eng&n 3e$e*&.&n 1B2 g!&m4&m 20B90.e.e+ *e! meni.7"

– Pembe!i&n me-&-,i in.!&m,+3,-e! +e$&!& be!3&-&

• D#+i+ &&-: g!&m MgSO 20$$ MgSO 20 87 ibe!i3&n

+e$&!& i" eng&n 3e$e*&.&n 1 g!&mmeni."


15/21

• Ob&.B#b&. +,*#!.i( : – Di,!e.i3,m) .i&3 ibe!i3&n 3e$,&-i bi-& && :

– Eem& *&!,

– P&/&% 4&n.,ng 3#nge+.i(

– Eem& &n&+&!3&

– Ob&.B#b&. An.i%i*e!.en+i ibe!i3&n bi-& Te3&n&n

&!&% +i+.#-i3 150 mmHg) i&+.#-i3110mmHg" Ob&. &n.i%i*e!.en+i /&ng ibe!i3&n:

• Ob&. *i-i%&n &&-&% %i!&-&in

mg i"" *e-&nB*e-&n +e-&m& meni." D#+i+ &*&.i,-&ng &-&m &3., 1B20 meni. +&m*&i .e!$&*&i.e3&n&n &!&% /&ng iingin3&n) /&i., *en,!,n&n MAP

+eb&n/&3 208 &!i &&-"


16/21

– P&+ien /&ng meng&-&mi 3e4&ngB3e4&ng +e$&!&be!.,!,.&n +.&.,+ 3#n,-+i,+7) ibe!i3&n *eng#b&.&n

+eb&g&i be!i3,. :• S,n.i3&n ;en#i&e*in 1 &m*,- 10 mg7 i"" *e!-&%&nB-&%&n"

• ;i-& *&+ien m&+i% .e.&* 3e4&ng) ibe!i3&n +,n.i3&n ,-&ng"

• ;en#i&e*in i"" +e.i&* 4&m +&m*&i 9 3&-i be!.,!,.B.,!,."

• Se-&in ;en#i&e*in) ibe!i3&n 4,g& P%eni.#in ,n.,3men$eg&% 3e4&ng ,-&ng&n7 eng&n #+i+ 9 > 900 mg 93&*+,-7 %&!i *e!.&m&) 9 > 200 mg 2 3&*+,-7 *&& %&!i3e,&) &n 9 > 100 mg 1 3&*+,-7 *&& %&!i 3e.ig& &n+e.e!,+n/&"

• A*&bi-& +e.e-&% *embe!i&n ;en#i&e*in i"" 9 3&-i be!.,!,.B

.,!,. *&+ien m&+i% .e.&* 3e4&ng) m&3& ibe!i3&n .e.e+&-i,m Di&e*&m 0 mg &m*,- i &-&m 20 $$ N&?- 0"<87 eng&n 3e$e*&.&n 20B2 .e.e+meni. +e-&m& 2 %&!i"


17/21

• Pe!&&.&n *&+ien eng&n 3#m& :

– R&&. be!+&m& eng&n ;&gi&n S&!&( :

• Dibe!i3&n in(,+ $&i!&n M&ni.#- 20 8 eng&n $&!& : 200 $$

ig,/,!7) 6 4&m 3em,i&n ibe!i3&n 10 $$ ig,/,!7) 6 4&m 3em,i&n 10 $$ -&gi ig,/,!7" T#.&- *embe!i&n 00$$ +e%&!i" Pembe!i&n i-&3,3&n +e-&m& %&!i"

• D&*&. 4,g& ibe!i3&n $&i!&n g-i+e!#- 10 8 eng&n3e$e*&.&n 90 .e.e+meni. +e-&m& %&!i"

• D&*&. 4,g& ibe!i3&n De>&me.%&+#n i"" > 5 mg +e%&!i)/&ng 3em,i&n i tappering o "

– M#ni.#!ing 3e+&&!&n &n &-&mn/& 3#m& eng&nmem&3&i Glasgow-Pittsburgh-Coma Scale"

– P&& *e!&&.&n 3#m& *e!-, i*e!%&.i3&n *en$eg&%&ne3,bi.,+"

– P&& 3#m& /&ng -&m&) *embe!i&n n,.!i+i me-&-,i NGT NasoGastric Tube7"

•


18/21

P&& *&+ien ini .&n&B.&n& e3-&m+i& m,-&i .e!4&i *&&mingg, 3e,& *#+.*&!.,m eng&n m,n$,-n/& ge4&-& 3e4&ng.#ni3B3-#ni3 *&& +e-,!,% b&&n" Me+3i*,n 3e4&ng &*&. i&.&+i

n&m,n 3e4&i&n e3-&m+i m&+i% .e.&* be!-&n4,. +&m*&i mingg,3eem*&. *#+.*&!.,m eng&n .&n&B.&n& n/e!i 3e*&-&) m,&-&n m,n.&%) *&n&ng&n 3&b,! &n bing,ng" A&n/& .&n&B.&n& .e!+eb,. *e!-, i$,!ig&i &&n/& -&.e *#+.*&!.,me$-&m*+i&" Pe!3emb&ng&n e3-&m+i& *#+.*&!.,m &*&. .e!4&i 9B mingg, +e.e-&% 3e-&%i!&n"

P&+ien &.&ng 3e UGD RSML eng&n 3e-,%&n 3e4&ng P&+ien 3e4&ng+e4&3 2 4&m SMRS) i IGD *&+ien 3e4&ng +eb&n/&3 >" S&&. 3e4&ng *&ien

.i&3 +&&! +e3i.&! meni.) +e-,!,% b&&n 3&3,) -i&% 3&3,) m&.&me-i!i3 3e &.&+" Di &n.&!& 3e4&ng *&+ien +&&!) menge-,% *&n&ng&nge-&*) 3e*&-& i!&+&3&n *,+ing .i&3 be!*,.&!) m,&-) .i&3 i&*&.3&nm,n.&%) &n n/e!i *e!,. b&&%" Ri&/&. .!&,m& i+&ng3&-) 3e-,%&n-em&% +e*&!#% b&&n i+&ng3&-) !i&/&. 3e4&ng +ebe-,mn/& i+&ng3&-"Sebe-,mn/& *&+ien menge,% n/e!i 3e*&-& 6 4&m SMRS" P#+. S? i

RSUD 2 mingg, /&ng -&-, 5 =&n 20167"

PEM%AHASAN


19/21

;ebe!&*& *ene-i.i men/eb,.3&n 08 3e4&ng .e!4&i&n.e*&!.,m) 28 in.!&*&!.,m) &n 28 *#+.*&!.,m"Pene-i.i -&in men/eb,.3&n %&+i- /&ng be!be& b&%&3e4&ng *&& e3-&m+i& .e!4&i 68 *#+.*&!.,m) 958&n.e*&!.,m) &n 158 in.!&*&!.,m" E3-&m+i& *#+.

*&!.,m &*&. .e!4&i 3&!en& *&& +&&. i., -ee-+,b+.&n+i 3#n+.!i3.#! /&ng i-e*&+3&n #-e% *-&+en.&&3&n men,!,n +e%ingg& &3&n .e!4&i #e!*e!(,+i &!&%+e!eb!&-"

Pene-i.i&n .e!b&!, men/eb,.3&n b&%& e3-&m*+i& b&n/&3 .e!4&i *&&

ib, /&ng 3,!&ng men&*&.3&n *e-&/&n&n AN? /&i., +ebe+&! 6)18ib&ning3&n eng&n /&ng men&*&.3&n AN? +ebe+&! 1)


20/21

Dib&ning3&n eng&n (eni.#in) m&gne+i,m +,-(&. 4,g& -ebi%e(e3.i( ,n.,3 .e!&*i e3-&m+i& &n &*&. meng,!&ngi !e3,!en+i 3e4&ng*&& e3-&m+i&" Me3&ni+me 3e!4& m&gne+i,m +,-(&. &&-&% eng&nmemb-#3 !e+e*.#! NMDA /&ng be!*e!&n *&& .e!4&in/& 3e4&ng) &.&,memb-#3 *in., 3&-+i,m /&ng i*e!-,3&n ,n.,3 3#n.!&3+i #.#. *#-#+&+3,-e! +e%ingg& &*&. i*e!g,n&3&n ,n.,3 men$eg&% &+#+*&+me*&& e3-&m+i&"

D&.& men,n4,33&n b&%& e(e3 i-&.&.#! *emb,-,% &!&% +i+.emi3-ebi% *!#minen &!i*&& &+#i-&.&.#! +e!eb!&-n/& +e%ingg& &3&nmen,!,n3&n .e3&n&n *e!(,+i +e!eb!&- /&ng &3&n men$eg&% .e!4&in/&

,em +e!eb!i" E(e3 ini-&% /&ng memb,&. m&gne+i,m +,-(&. *en.ing&-&m me3&ni+me *ene3&n&n 3e4&ng" ;ebe!&*& *ene-i.i&n #-e% D,-e/33" men,n4,33&n b&%& m&gne+i,m +,-(&. me!,*&3&n *i-i%&n ,.&m&,n.,3 men$eg&% e3-&m+i&" M&gne+i,m +,-(&. .e!b,3.i -ebi% e(e3.i(&!i*&& i&e*&m ,n.,3 .e!&*i &n *en$eg&%&n e3-&m+i&"

K i. i E i. 3 i. i . 3 . 3 i 3- i K i. i


21/21

K!i.e!i& Een) /&i., 3!i.e!i& ,n.,3 menen.,3&n *!#gn#+i+e3-&m*+i&" K!i.e!i&Een &n.&!& -&in:

1" 3#m& /&ng -&m& *!#-#nge $#m&72" n&i i&.&+ 1209" +,%, 9

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