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  1. 1. Preeclampsia Preeclampsia is a pregnancy disorder of blood pressure elevation and the discovery of protein in the urine (proteinuria) after the 20th week of pregnancy.<br />In addition to hypertension and proteinuria, some symptoms that may accompany preeclampsia include: <br />     * Great Headaches <br />     * Disturbance of vision<br />      * Abdominal pain upper <br />     * Nausea or vomiting <br />     * Dizziness <br />     * Urine is less <br />     * Sudden increase in weight. <br />Swelling (edema), especially in the face and hands often accompanies preeclampsia. However, edema is not a sure sign of preeclampsia because of this phenomenon is also found in normal pregnancy.<br />The exact cause of preeclampsia is unknown. However, some things that allegedly contribute to the occurrence of preeclampsia are: <br />     * Lack of blood flow to the uterus <br />     * Damage to blood vessels <br />     * Ganggguan immune system<br />      * Poor nutrition<br />Complications of preeclampsia include: <br />     * Decreased blood flow to the placenta, which can cause fetal growth, preterm birth, or fetal death in utero. <br />     * Disposal of the placenta prematurely.<br />      * HELLP syndrome, characterized by hemolysis, elevated levels of liver enzymes and low platelet count.<br />      * Eclampsia, preeclampsia is accompanied by seizures. This situation is very dangerous because it may cause damage to organs such as liver, kidney, and brain, which ended with the death. <br />Some therapies that can be done in preeclampsia: <br />Rest lying <br />If the pregnancy is still young and still mild preeclampsia, usually recommended to rest lay to lower blood pressure and increase blood flow to the placenta. In addition examination of blood pressure, urine protein levels, and the state of the baby on a regular basis. If severe preeclampsia, rest should be lying in a hospital. Regular examinations are usually required to determine the state of the mother and baby. Another ultrosonografi examination is to determine the volume of amniotic fluid. <br />Medicines and drugs <br />The drugs are usually given to lower blood pressure until the time of delivery. If severe preeclampsia or HELLP syndrome occurs, then given corticosteroids. Corticosteroids may improve liver function and platelets. In addition, useful to mature fetal lungs. Childbirth If preeclampsia occurs last weeks of pregnancy, it can be done to accelerate delivery. To expedite delivery pregnancy can be induced with drugs, or operating faults (C-section). During the process of birth, the mother may be given magnesium sulfate intravenously. After birth, the mother's blood pressure normally expected in a few days or wee<br />GROWTH BABY FIRST YEAR<br />There are theories that calculate how many hours before in partu, eg 2 or 4 or 6 hours before in partu. There is also a state in the cervical opening size when I, for example, a rupture of membranes before the opening of the cervix 3 cm or 5 cm, and so on. The principle is the rupture of membranes " before time" . <br />The problem: When membranes rupture (spontaneously) in a normal delivery? Normal membranes rupture at the end when I or II when labor early. Could also not broken until the bearing, so that sometimes needs to be solved (amniotomi). EARLY rupture is closely linked to Preterm labor INTRAPARTUM AND INFECTION<br />Pathophysiology Many theories, ranging from chromosomal defects, abnormalities of collagen, to the infection. In most cases the infection was associated with (up to 65%). High virulence: Bacteroides. Low virulence: lactobacillus.<br />Collagen found in amniotic kompakta layer, fibroblasts, reticular tissue and chorion trophoblast. Synthesis and degradation of collagen tissue is controlled by the system activity and inhibition of interleukin-1 (IL-1) and prostaglandins. <br />If there is infection and inflammation, there is increased activity of IL-1 and prostaglandins, produce kolagenase tissue, resulting in collagen in the membrane depolimerisasi chorion / amnion, causing thin membranes, weak and easily broken spontaneously. The risk factors / predisposing premature rupture of membranes / preterm labor multiple pregnancy: twins (50%), triplets (90%) <br />history of previous preterm labor: risk 2 - 4x<br />act of copulation: NOT affect the risk, EXCEPT if you bad hygiene, predisposing to infection vaginal bleeding: the first trimester (2x risk), second trimester / third (20x) <br />bacteriuria: risk 2x (prevalence 7%) <br />vaginal pH above 4.5: the risk of 32% (vs. 16%)<br /> servix thin / less than 39 mm: the risk of 25% (vs. 7%)<br /> abnormal vaginal flora: 2-3x risk <br />fibronectin> 50 ng / ml: the risk of 83% (vs. 19%)<br /> levels of CRH (corticotropin releasing hormone) in such a high maternal psychological stress, etc., can be stimulated preterm labor <br />Strategy on antenatal care<br /> - Detection of risk factors <br />- Early detection of infection <br />- Ultrasound: biometry and funelisasi <br />First trimester: detection of risk factors, sexual activity, vaginal pH, ultrasound, Gram examination, routine blood, urine.<br />The second and third trimester: be careful when there were complaints of pain abdomen, back, cramps in the pelvic area as being periods, vaginal bleeding, pink mucus, vaginal discharge, polyuria, diarrhea, feeling pressure in the pelvis. <br />If the membranes rupture: do not often check in!! Watch the signs of complications. Complications of premature rupture of membranes <br />Intra Partum infection (Chorioamnionitis) ascendens from the vagina to intrauterin. preterm labor, if it occurred at preterm gestation. <br />umbilical cord prolapse, can be reached critical embryonic and fetal death due to hypoxia (often occur on the buttocks or the location of the presentation latitude). <br />oligohidramnion, partus often dry (dry labor) due to low amniotic fluid. Circumstances / factors that are associated with preterm partus <br />iatrogenic: lack of hygiene (especially), traumatic action <br />maternal: systemic diseases, pathology or pelvic reproductive organs, pre-eclampsia, trauma, alcohol consumption or illicit obat2, intraamnion subklinik infection, clinical Chorioamnionitis, incompetent cervix, servisitis / vaginitis Acute rupture in preterm gestation. <br />fetal: fetal malformations, multiple pregnancies, hidrops fetalis, stunted fetal growth, severe fetal, fetal death. <br />amniotic fluid: oligohidramnion with intact membranes, preterm rupture of, infection intraamnion, Chorioamnionitis clinic. <br />placenta: solutio placenta, placenta praevia (35 weeks of pregnancy or more), sinus maginalis, chorioangioma, vasa praevia. <br />uterus: uterine malformations, overdistensi acute, large uterine, desiduositis, idiopathic uterine activity. <br />Preterm labor (partus prematurus): labor pregnancy occurs at age between 20-37 minggu.Tanda: contractions with an interval of less than 5-8 ', accompanied with progressive cervical changes, cervical dilatation 2 cm real or more, and continues until the cervix thinning more than 80%. The average incidence in large rumahsakit2 in Indonesia: 13.3% (10-15%) (preterm labor - no lectures themselves)<br />Preeklamsia Pre-eklampsia adalah suatu gangguan kehamilan tekanan darah elevasi dan penemuan protein dalam urin (proteinuria) setelah minggu ke-20 kehamilan. <br />Selain hipertensi dan proteinuria, beberapa gejala yang mungkin menyertai pre-eklampsia meliputi:       * Great Headaches <br />      * Gangguan penglihatan <br />       * Nyeri perut bagian atas <br />      * Mual atau muntah <br />      * Pusing <br />      * Urine kurang<br />      * Tiba-tiba kenaikan berat badan.<br />Pembengkakan (edema), terutama di wajah dan tangan seringkali menyertai preeklampsia. Namun, edema bukanlah tanda pasti preeklampsia karena fenomena ini juga ditemukan pada kehamilan normal.<br />Yang tepat penyebab preeklamsia tidak diketahui. Namun, beberapa hal yang diduga berperan dalam terjadinya preeklamsia adalah:<br />Kurangnya aliran darah ke rahim <br />Kerusakan pembuluh darah <br />Ganggguan sistem kekebalan <br />Kurang gizi <br />  Komplikasi pre-eklampsia meliputi:<br />Berkurangnya aliran darah ke plasenta, yang dapat menyebabkan pertumbuhan janin, kelahiran prematur, atau kematian janin dalam rahim.<br />pelepasan plasenta prematur. <br />Sindrom HELLP, ditandai dengan hemolisis, peningkatan kadar enzim hati dan jumlah platelet rendah.<br />Eklampsia, pre-eklampsia disertai dengan kejang. Situasi ini sangat berbahaya karena dapat menyebabkan kerusakan organ seperti hati, ginjal, dan otak, yang berakhir dengan kematian.<br />Beberapa terapi yang dapat dilakukan dalam preeklamsia:<br />Istirahat berbaring Jika kehamilan masih muda dan preeklampsia masih ringan, biasanya dianjurkan untuk beristirahat berbaring untuk menurunkan tekanan darah dan meningkatkan aliran darah ke plasenta. Selain pemeriksaan tekanan darah, tingkat protein urin, dan keadaan bayi secara teratur. <br />Jika preeklamsia berat, istirahat harus terbaring di rumah sakit. Pemeriksaan rutin biasanya diperlukan untuk menentukan keadaan ibu dan bayi. Ultrosonografi lain pemeriksaan adalah untuk menentukan volume cairan ketuban. Obat-obatan dan obat-obatan <br />Obat-obatan biasanya diberikan untuk menurunkan tekanan darah sampai saat melahirkan. Jika preeklamsia berat atau terjadi sindrom HELLP, maka diberikan kortikosteroid. Kortikosteroid dapat memperbaiki fungsi hati dan platelet. Selain itu, berguna untuk dewasa paru-paru janin. <br />Melahirkan Jika preeklampsia terjadi minggu-minggu terakhir kehamilan, hal itu dapat dilakukan untuk mempercepat pengiriman. Untuk mempercepat pengiriman kehamilan dapat diinduksi dengan obat-obatan, atau kesalahan operasi (C-section). Selama proses kelahiran, ibu dapat diberikan magnesium sulfat intravena. Setelah lahir, tekanan darah ibu diharapkan normal dalam beberapa hari atau wee<br />TAHUN PERTAMA PERTUMBUHAN BAYI<br />Ada teori yang menghitung berapa jam sebelum di partu, misalnya 2 atau 4 atau 6 jam sebelum di partu. Ada juga negara dalam ukuran pembukaan serviks ketika saya, misalnya, pecah ketuban sebelum pembukaan serviks 3 cm atau 5 cm, dan seterusnya. Prinsipnya adalah ketuban pecah " sebelum waktu" .<br />Masalahnya: Ketika selaput ketuban pecah (spontan) dalam pengiriman normal? Normal selaput ketuban pecah pada akhir ketika saya atau II saat tenaga kerja lebih awal. Bisa juga tidak rusak sampai bantalan, sehingga kadang perlu dipecahkan (amniotomi). AWAL pecah berhubungan erat dengan persalinan prematur INTRAPARTUM DAN INFEKSI Patofisiologi Banyak teori, mulai dari kerusakan kromosom, kelainan kolagen, sampai infeksi. Dalam kebanyakan kasus infeksi dikaitkan dengan (hingga 65%). <br />High virulensi: Bacteroides. Virulensi rendah: lactobacillus.<br />Kolagen ditemukan di lapisan kompakta amnion, fibroblas, jaringan dan chorion retikuler trofoblas. Sintesis dan degradasi jaringan kolagen dikontrol oleh sistem aktifitas dan inhibisi interleukin-1 (IL-1) dan prostaglandin.<br />Jika ada infeksi dan inflamasi, terjadi peningkatan aktivitas dari IL-1 dan prostaglandin, menghasilkan jaringan kolagenase, mengakibatkan kolagen pada selaput korion depolimerisasi / amnion, menyebabkan selaput tipis, lemah dan mudah pecah secara spontan. Faktor risiko / predisposisi ketuban pecah dini / persalinan prematur kehamilan kembar: kembar (50%), kembar tiga (90%)<br />Riwayat persalinan prematur sebelumnya: risiko 2 - 4x <br />Tindakan sanggama: TIDAK mempengaruhi risiko, KECUALI jika higiene buruk, predisposisi terhadap infeksi pendarahan vagina: trimester pertama (risiko 2x), trimester kedua / ketiga (20x)<br />bakteriuria: risiko 2x (prevalensi 7%) <br />pH vagina di atas 4.5: risiko 32% (vs 16%)<br />servix tipis / kurang dari 39 mm: risiko 25% (vs 7%)<br />flora vagina abnormal: risiko 2-3x<br />fibronectin> 50 ng / ml: risiko 83% (vs 19%)<br /> kadar CRH (kortikotropin releasing hormone) sedemikian stres psikologis ibu yang tinggi, dll, dapat merangsang persalinan prematur Strategi pada perawatan kehamilan<br />- Deteksi faktor risiko <br />- Deteksi dini infeksi<br />- USG: biometri dan funelisasi Trimester pertama: deteksi faktor risiko, aktifitas seksual, pH vagina, USG, pemeriksaan Gram, darah rutin, urin. Kedua dan trimester ketiga: hati-hati saat ada keluhan nyeri perut, punggung, kram di daerah panggul sebagai menstruasi, perdarahan vagina, lendir merah muda, discharge vagina, poliuria, diare, merasa tekanan di panggul. Jika selaput ketuban pecah: jangan sering check-in!! Perhatikan tanda-tanda komplikasi. Komplikasi ketuban pecah dini <br />1. Intra Partum infeksi (Korioamnionitis) ascendens dari vagina untuk intrauterin. persalinan prematur, jika itu terjadi pada kehamilan prematur. 2. prolaps tali pusat, dapat dihubungi kritis janin dan kematian janin akibat hipoksia (sering terjadi pada pantat atau lokasi presentasi lintang). 3. oligohidramnion, sering partus kering (kering tenaga kerja) karena rendahnya cairan ketuban. <br />Keadaan / faktor-faktor yang terkait dengan partus preterm 1. iatrogenik: hygiene kurang (terutama), tindakan traumatik 2. maternal: penyakit sistemik, patologi organ reproduksi atau pelvis, pre-eklampsia, trauma, konsumsi alkohol atau obat2 terlarang, infeksi intraamnion subklinik, klinis Korioamnionitis, tidak kompeten serviks, servisitis / vaginitis akut pecah pada kehamilan prematur.<br />3. janin: malformasi janin, kehamilan multipel, hidrops fetalis, pertumbuhan janin terhambat, berat janin, kematian janin.<br />4. cairan ketuban: oligohidramnion dengan selaput utuh, pecah prematur, infeksi intraamnion, Korioamnionitis klinik.<br />5. plasenta: solutio plasenta, plasenta praevia (35 minggu kehamilan atau lebih), sinus maginalis, chorioangioma, vasa praevia.<br />6. uterus: malformasi uterus, overdistensi akut, besar rahim, desiduositis, aktifitas uterus idiopatik.<br />Persalinan prematur (partus prematurus): tenaga kerja terjadi pada usia kehamilan antara 20-37 minggu.Tanda: kontraksi dengan interval kurang dari 5-8 ', disertai dengan perubahan serviks progresif, dilatasi serviks nyata 2 cm atau lebih, dan berlanjut sampai rahim menipis lebih dari 80%.<br />Rata-rata insiden rumahsakit2 besar di Indonesia: 13,3% (10-15%) (persalinan prematur - tidak ada kuliah sendiri)<br />