Selasa, 19 Februari 2013

PRE ECLAMPSIA AND ECLAMPSIA


Definition
            
Pre-eclampsia and eclampsia, a disease entity, which directly caused by the pregnancy, although it is not clear how it happened. Pre eklamasi followed by the onset of hypertension accompanied by protein urine and edema of pregnancy after 20 weeks gestation or shortly after birth (Yayasan Bina Obstetrics Library Sarwono Prawiharjo, Fac. UI Jakarta, 1998).
            
The diagnosis of pre-eclampsia is confirmed by the presence of two of the three symptoms, namely excessive weight gain, edema, hypertension and proteinuria. Excessive weight gain in the event of a 1 Kg how many times a week. Edema was seen as weight gain, swelling of legs, fingers, and face. Blood pressure> 140/90 mmHg or systolic pressure increased> 30 mmHg or diastolic pressure> 15 mmHg were measured after the patient rest for 30 minutes. (Capita Selekta Medicine, Mansjoer Arif, Media Aesculapius, Jakarta, 2000).

Etiology
            
The cause of preeclampsia is not known with certainty, many theories advanced by experts try to explain the cause, but there is no satisfactory answer. The theory is that the current theory of ischemic placenta. But this theory has not been able to explain all the things associated with this disease. (Yayasan Bina Obstetrics Library Sarwono Prawiharjo, Fac. UI Jakarta, 1998).

Classification of Pre-eclampsia
Pre-eclampsia is classified into 2 groups:
Mild pre-eclampsia:
- Increase in diastolic blood pressure of 15 mmHg or> 90 mmHg with 2 times the measurement within 1 hour or up to 110mmHg diastolic pressure.
- Increase in systolic blood pressure of 30 mmHg or> 140 mmHg or achieved.
- Positive urine protein 1, general edema, legs, fingers and face. The increase in BB> 1Kg/mgg.
      
Severe pre-eclampsia:
- Diastolic blood pressure> 110 mmHg
- Positive urine protein 3, oliguria (urine, 5gr / L). hiperlefleksia, visual disturbances, epigastric pain, there is edema and cyanosis, headache, impaired consciousness.


Pathology
            
Mild preeclampsia rarely cause maternal death. Therefore, most of the anatomic pathologic examination from patients who died of eclampsia. In the recent investigation by the liver and kidney biopsy turns out that the pathological-anatomical changes in the tools were in pre-eclampsia is not much different from the ditemukakan in eclampsia. It should be noted here that there is no typical histopathological changes in pre-eclampsia and eclampsia. Hemorrhage, infarction, nerkosis found in various organs. The changes are most likely caused by vasospasmus arterioles. Accumulation of fibrin in blood vessels is also an important factor in the pathogenesis of these disorders.

The changes in the organs:
1. Change of Heart
- Irregular bleeding
- There was necrosis, thrombosis in liver lobes
- Pain in the epigastrium due to bleeding subkapsuler
2. Retina
- Areriol spasm, edema around the optic disc
- Retinal detachments (retinal detachments)
- It causes blurred vision
3. Brain
- Spasm of blood vessels causes brain arterioles brain tissue anemia, hemorrhage and necrosis
- Creates a severe headache
4. Lungs
- Various levels of edema
- Bronkopnemonia until the abscess
- Potential blown up cyanosis
5. Heart
- Changes in fatty degeneration and edema
- Bleeding sub-endokardial
- Potential cardiac dekompensasio until cessation of heart function
6. Blood flow keplasenta
- Spasms are sudden arterioles causing severe asphyxia until kemaian fetus
- Prolonged spasm, interfere with fetal growth
7. Changes in renal
- Spasms arterioles causes decreased blood flow to the kidneys is reduced so fitrasi glomerolus
- Absorption of water and salt tubules persist water and salt retention
- Edema in the legs and arms, the lungs and other organs
8. Changes in the blood vessels
- The higher the permeability of the protein, causing the protein to the network vasasi
- Protein interesting extravascular water and salt cause edema
- Blood hemoconcentration that causes metabolic dysfunction and thrombosis.

(Obstetrics, Gynecology and Family Planning Midwife for Education, Ida Bagus Gede Manuaba, Jakarta: EGC, 1998).

Clinical Pre-eclampsia
            
Starting with edema followed by weight gain. On the feet and hands, increase in blood pressure, proteinuria and last occurred. In mild preeclampsia symptoms of opinion has not been found, but in severe pre-eclampsia followed complaints as follows:
- Headaches, especially frontal areas
- Epigastric pain areas
- Impaired vision
- There till nausea vomiting
- Respiratory problems until cyanosis
- Disorders of consciousness

Diagnosis
            
In general, the differential diagnosis between pre-eclampsia with hypertension or kidney disease not manahun rarely cause trouble. In chronic hypertension whose blood pressure rises before hamil.pada young or months postpartum state will be very useful to make a diagnosis.
            
For the diagnosis of kidney disease at the onset of proteinuria much help. Proteinuria in pre-eclampsia rarely occur before TM to 3, whereas in kidney disease arises first.
(Yayasan Bina Obstetrics Library Sarwono Prawiharjo, Fac. UI Jakarta, 1997).
 
Prevention of Pre-eclampsia
            
There is no agreement in the pre-eclampsia prevention strategies. Some studies show nutritional approach (low-salt diet, diit high in protein, calcium supplements, magnesium, etc.). Or medikamentosa (theophylline, antihypertensives, diuretics, asapirin, etc.) can reduce the incidence of pre-eclampsia.
(Capita Selekta Medicine, Mansjoer Arif ... Media Aesculapius, New York: 2000)

Handling
The main purpose of treatment is to:
- Prevention of pre-eclampsia happened heavy and eclampsia
- Maternity fetal life
- Maternity fetal trauma smallest detail.
            
Basically the treatment consists of medical and obstetric management.
Handling Obstetric intended to give birth at the optoimal the sebvelum dead fetus in utero but already mature enough to live outside the uterus.
In general, indications for treating patients with pre-eclampsia in the hospital is
- Siscol blood pressure 140 mm Hg or greater and diastolic blood pressure 90 mmHg, protein +1 or more.
- Weight gain 1.5 kg or more in a week again
- Addition of a sudden excessive edema

Handling of mild pre-eclampsia
          
Bed rest is a therapy for the treatment of pre-eclampsia. Break by lying body position causes blood to the placenta increases drainage, blood flow to the kidneys also elbih much. The pressure on the bottom ekstermitas resobsi down and blood flow increases. It also reduces the need for the circulating blood volume. Therefore, the blood pressure usually breaks down and Adema reduced. Giving phenobarbital 3 x 30mg a day will improve patient and can also lower blood pressure.
      
In general, diuretics and anti-hypertensive mild pre-eclampsia is not recommended because these drugs do not stop the disease process and did not improve fetal prognosis. In addition, the use of these drugs may mask the signs and symptoms of severe pre-eclampsia.
      
After normal circumstances, patients are allowed to go home, but to be forced more often. Because usually old women, labor no longer. If hypertension persists, patients stay in the hospital. When circumstances permit fetus, waiting to do the induction of labor, to labor just months or> 37 weeks.
      
Some cases of mild pre-eclampsia does not improve with conservative treatment. Increased blood pressure, fluid retention, and proteinuria increased, although the patient rest with medical treatment. In this case, termination of pregnancy carried out although the fetus is still premature.
(Yayasan Bina Obstetrics Library Sarwono Prawiharjo, Fac. UI Jakarta, 1998).

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