Jumat, 29 Oktober 2010

MODERATE PREECLAMPCIA

Moderate Preeclampsia

UNDERSTANDING
Incidence of hypertension accompanied by urine protein and / or edema after 2 weeks of pregnancy.
Pathophysiology
The cause is not really clear until now. The disease is regarded as a "Maladaptation Syndrome" with vasospasm due to a general with all its consequences
CLINICAL SYMPTOMS
The increase in systole blood pressure> 30 mmHg or diastole of> 15 mmHg (from blood pressure before pregnancy) at 20 weeks or more, or systole> 140 (<160 mmHg). Diastole> 90 mmHg (<110mmHg).
Urine Protein:
0.3 gr / lt in 24 hours or a qualitative ().
Edema at:

    
* Pretibia
    
* The walls of the stomach
    
* Lambosakral
    
* Face / hand
INVESTIGATION / DIAGNOSIS
Pregnancy> 20 weeks
The increase in blood pressure (> 140/90 mmHg) with 2 x hose 6jam examination during rest. (For the first examination carried out after a break of 2 x 10 minutes).
Edema: edema tean at:

    
* Limbs (pre tibial)
    
* The walls of the stomach
    
* Lumbosakral
    
* Face / hand
Urine Protein -> 0,3 gr/lt/24 hours

    
* Qualitative ()
DIAGNOSIS OF APPEAL
1. Chronic Hypertension
Existing hypertension 20 weeks or settled after 6 weeks postpartum
2. "Transient" hypertension:
Arise hypertension without other symptoms and disappear after 10 days postpartum
MANAGEMENT
A. Outpatient

    
* Lots of Rest (lie / sleep on)
    
* Diets high in protein as possible low-carb.
    
* Conducted inspection fetal welfare assessment in pregnancies at> 30 weeks, and repeated at least within 2 weeks
* USG (ultrasonography)
* NST (Non Stress Test)

    
* Laboratory tests:
* PCV, Hb
* Uric Acid blood
* Platelets

    
* The drugs are given:
* Roboransia, vitamin combination.
* 1 x Low-dose aspirin a day (87.5 mg)

    
* Visit again 1 week
B. Outpatient Stay
B.1. Criteria for Hospitalization stay for patients with mild pre-eclampsia
1. Results kesehjateraan fetal assessment in doubt or bored (examination in pregnancy> 30 weeks)
2. The trend towards pre-eclampsia severe symptoms (arising from one or more symptoms of severe pre-eclampsia)
B.2. Treatment and evaluation during hospitalization stay
1. Patients with a total bed rest
2. Drugs:
- Roboransia, vitamin combinations
- 1 x Low-dose aspirin daily
3. Laboratory tests:
- Hb, PCV
- Blood uric acid
- Platelets
- The function of kidney / liver
- Urine complete
4. Conducted assessment of fetal well-being
B.3. Evaluation of treatment outcome
Basically, medical evaluation is based on the results of the assessment of fetal well-being:
When the obtained results:
1. Bad: termination of pregnancy with Seksio Fault (in pregnancy> 30 weeks)
2. In doubt: re-evaluation of the NST performed 1 day later
3. Good: patients treated at least 4 days, when the pregnancy prematurely discharged patients and outpatients. In pregnancy aterm with pelvic score a mature (> 5) induction with oxytocin drip. When the pelvic score immature (<5) patients discharged and outpatient care, control 1 week
4. Termination of pregnancy was also done when didiapatkan signs of impending eclampsia of the mother.


COMPLICATIONS
1. severe preeclampsia s / d eclampsia
2. Failure on the organs: liver, kidney, son kidney, lung, heart, and CVA (brain)
3. Fetus:

    
* Premarutis
    
* IUGR
    
* Emergency fetus
    
* The death of the fetus in utero (IUFD).

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