The document outlines essential knowledge and practices in obstetrics and gynecology, emphasizing the importance of mastering basic concepts and continuous learning. It discusses physiological changes during normal pregnancy and the need for early identification of high-risk pregnancies, alongside updated guidelines for managing conditions like preeclampsia. Recommendations include low-dose aspirin for prevention, clearly defined screening and diagnosis criteria, and specific timing for delivery based on gestational conditions.

1. DALAM MEMPELAJARI PERKEMBANGAN OBETETRI & , GINEKOOGI HARUS SELALU
Terlebih dahulu MENGUASAI DAN MEMAHAMI :
1. PENGETAHUAN BASIC (dasar)
2.KEMBALI KE BASIC ! KEMBALI KE BASIC!
3.BACK TO BASIC BODY OF KNOWLEDEGE
4. BACK TO BASIC BODY OF THEORY

2. BELAJAR YANG BAIK DALAM MENAMBAH ILMU IALAH, BILA
1. MENDAPAT PENGETAHUAN BARU
2. Bersamaan itu MENARIK KEMBALI (mengingat kembali)
ilmu yang telah didapat sebelumnya
1. BELAJAR PRAKTEK DITEMPAT YANG RELEVANT DENGAN ILMU
YANG TELAH DIPELAJARI

3. PERUBAHAN2 DASAR FISIOLOGIK KARDIOVASKULER PADA
KEHAMILAN NORMAL ITU APA ??
1. Penurunan Systemic Vascular Resistance : VSD
2.Penambahan Volume intravaskuler : mencapai 50 % : myocardiopathy
3.Peningkatan Volume intravaskuler post partum ,berasal dari :
kontraksi involusi
mobilisasi cairan ekstra vaskuler ; Mitral stenosis Edema paru
4.Hipercoagulability : thromboemboli,artificial heart valve
5.Peningkatan tinggi Cardiac output :aorta stenosis,hpp

4. TUJUAN UTAMA prenatal care adalah identifikasi dini :
1.ibu dengan naikya risiko
komplikasi medis,dll
komplikasi kehamilan,
komplikasi janin (abnormal).
2. ada kesempatan untuk
mendiskusikan masalah2 tersebut
sampai rencana management dan intervensi
3. Yang ideal : mulai
premarriage counselling
preconception counselling
prenatal care
Intinya adalah screening dan case finding

5. TUJUAN GUIDIELINE
1.meringkas kumpulan ilmu/opini 2 baru( current knowledge)
2.menyiapkan best-practice
3.mengidentifikasi masalah yang perlu riset lanjutan
Contoh :
American College of Obstetricians and Gynecologists (ACOG) issued a 99-page in November 2013
Guideline Hypertension in Pregnancy
Prof Md 14,Prof MS 1,Prof PhD 1,Md 1,Non Md 3 : 19
GUDIELINE hanyalah RECOMMENDATIONS. Hanya RECOMMENDATIONS.!!!
Inagat r : hanya 6 dari 60 rekomendasi ACOG GUIDELINE
didasari bersamaan high-quality evidence dan a strong recommendation.
Berarti ada ruang untuk clinical judhgment dokter untuk individualiusasi manajeman
pada pasien tertentu
THERE IS NO AUTHORITY IN SCIENCE
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JANGAN TERKECOH
Kebijaakan,Pedoman,panduan,spo.
Bukan Standar.

6. Classification.
1.Preeclampsia “mild” or “severe” change to
“ preeclampsia without severe features”
and “preeclampsia with severe features.”
Diagnosis of proteinuria.
1.24-hour urine collection more than 300 mg of protein or a single-specimen urine
protein:creatinine ratio of 0.3 mg/dL or higher.
2.Dipstick values should only be used if these quantitative measures are unavailable.
Signs of severe disease.
1.Fetal growth restriction
2.and proteinuria of more than 5 g/24 hr
are no longer considered defining features of severe disease.
Screening for preeclampsia.
1. Doppler studies
2. and serum biomarkers is not recommended,
as there is no evidence that early identification translates to improved outcomes
.
“
“PARADIGM SHIFT”According to ACOG 2013
TO SHOW THE MOST IMPORTANT PARADIGM SHIFT
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7. Prevention of preeclampsia.
Low-dose aspirin (60–80 mg/d, starting in the late first trimester) should be offered as
primary prevention to:
a.women with a history of early-onset preeclampsia , delivery before 34 weeks
b.women with a history of preeclampsia in multiple pregnancies
c.other high-risk patients (chronic hypertension, diabetes).
Not recommended : vitamin C or E, salt restriction, or bed rest)
Magnesium Sulfate.
1. Universal prophylaxis with magnesium sulfate is not recommended for preeclampsia
2. unless severe features are present
3. or the patient’s clinical condition changes to severe during labor.
Timing of delivery.
1.gestational hypertension or preeclampsia without severe features: 37 weeks’ gestation
2.preeclampsia with severe features: by 34 weeks
3.chronic hypertension: not before 38 weeks
4.hypertension with superimposed preeclampsia: 34 or 37 weeks, depending on the
presence of severe features.
Postpartum hypertension. The need for recognition of hypertension in the postpartum period is
emphasized, as well as appropriate management, using the following guidelines:
Also, because the use of NSAIDs is widespread for postpartum pain control, a culture change is needed
if we are to follow the postpartum recommendations.
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