14. Abnormal Pregnancy

Question 1

Chronic Hypertension in Pregnancy

Answer 1

Sudah hipertensi sebelum hamil atau BP ≥ 140/90 sebelum usia kehamilan 20 minggu

Question 2

Gestational HTN

Answer 2

Jika dicek 2x dalam minimal interval 6jam, BP ≥140/90 setelah usia kehamilan 20 minggu. (-) Proteinuria

Question 3

Preeclampsia

Answer 3

Jika dicek 2x dalam minimal interval 6jam, BP ≥140/90 setelah usia kehamilan 20 minggu. (+) Proteinuria. sebelumnya normal BP

Question 4

Superimposed preeclampsia

Answer 4

(+) proteinuria setelah 20 minggu. ada riwayat chronic HTN.
Jika hipertensi dan proteinuri sebelum 20 minggu, ada :
- peningkatan proteinuria dan BP yg tiba-tiba
- Platelet <100.000 = LOW
- peningkatan enzim liver (AST or ALT ≥70IU/L)

Question 5

Severe preeclampsia

Answer 5

• Jika dicek 2x dalam minimal interval 6jam, BP ≥160/110.
• Proteinuria ≥5g in 24h urine or ≥3+ in 2 random urine
• low platelet, high liver enzyme
• oliguria <500ml in 24h
• persistent headache and epigastric pain
• pulmonary edema and cyanosis

Question 6

HELLP Syndrome

complete? partial?

Answer 6

Tennessee classification

• hemolysis, dibuktikan dari serum LDH >600IU/L atau total bilirubin ≥1.2mg/dL
• elevated liver enzyme ≥70IU/L
• low platelet

partial jika memenuhi 1-2 kriteria saja.

Question 7

Eclampsia

Answer 7

Kejang disertai preeclampsia dan/atau HELLP syndrome

Question 8

definisi Preterm Labor ?

Answer 8

Lahir pada minggu 20-37 minggu
LBW
riwayat faktor risiko

Question 9

Management PTL ?

Answer 9

Bed rest
Start tocolytics (anti contraction)
Give Lung Maturation
Evaluate causal factor, start management
Evaluate the outcome
Provide join care with perinatology, if necessary may include referral

Question 10

Management hypertension in pregnancy ?

Answer 10

1. Depend on Gestational Age of pregnancy
2. Stabilization
3. Anti seizure & Anti hypertension
4. Lung Maturation (if preterm pregnancy)
5. Identify complication and management
6. Delivery timing and mode

Question 11

Definisi Placental abruption (solusio placenta)?
Definisi Placenta previa?
Perbedaan keduanya?

Answer 11

Solutio placenta : Lepasnya placenta dari dinding uterus sebelum waktunya.
Placenta Previa : Implantasi placenta di bawah rahim sampai menutupi canalis cervicalis

Perbedaan : kalo previa, terjadi pendarahan merah segar tanpa ada kontraksi uterus. Kalo solutio disertai kontraksi

Question 12

definisi Post partum hemorrhage ?

Answer 12

secara klinis : kehilangan darah ≥500ml pervaginal atau ≥1000ml CS
Disertai penurunan tanda vital : acral dingin, denyut nadi lemah, BP menurun

Question 13

Penyebab post partum hemorrhage?

primary vs secondary?

Answer 13

primary : tonus uteri, tissue, trauma, thrombin

secondary : infection, retained placental fragment, abnormal involution of placental site.

Question 14

Post term pregnancy
definisi?
komplikasi?
menejemen?

Answer 14

post term = ≥42minggu

complication :

• Fetal (meconium aspiration, intrauterine infection, oligo hydramnios, macrosomia, and perinatal mortality);
• Maternal (labor dystocia, perineal injury, and cesarean delivery).

menejemen : routine induction (oksitoksin, bisoprostol)