Risk Factors for Caesarean Section With Severe Pre Eclampsia

7/24/2019 Risk Factors for Caesarean Section With Severe Pre Eclampsia

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1

RISK FACTORS FOR CAESAREAN SECTION

WITH SEVERE PRE-ECLAMPSIA

Counselor:

Syafrial !r" S#"O$

Presen%e! &y:

A'un' A!(ya)sa &(as)ara * +,,,.,+/0

Nurul Pra%i1i - +,,,.,

2EPARTMENT OF O&STETR3 AN2 $3NECOLO$3

4EN2ERAL ACHMA2 3ANI 5NIVERSIT3

FAC5LT3 OF ME2ICINE

CIMAHI

67,


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CONTENTS

CONTENTS.............................................................................................................1

CHAPTER I INTRODUCTION..............................................................................2

CHAPTER II LITERATURE REVIEW..................................................................3

2.1 Definition...................................................................................................3

2.2 Sign and Sy!to"...................................................................................#

2.3 Diagno"i"...................................................................................................$

2.# %anageent..............................................................................................&

2.$ Co!'i(ation.............................................................................................)

2.& P*ogno"i"...................................................................................................)

CHAPTER III DISCUSSION..................................................................................+

CHAPTER IV SU%%AR,...................................................................................1-

REERENCES.......................................................................................................11


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CHAPTER II

LITERATURE REVIEW

2.1 Definition of P*e e('a!"ia

P*e e('a!"ia i" one of "e/e*a' ('ini(a' diagno"i" in 0y!e*ten"i/e di"o*de* in

!*egnan(y. Hy!e*ten"i/e di"o*de*" (o!'i(ating !*egnan(y a*e (oon and fo*

one of t0e dead'y t*iad a'ong it0 0eo**0age and infe(tion t0at (ont*i4te

g*eat'y to ate*na' o*idity and o*ta'ity. In 2--1 a((o*ding to t0e Nationa'

Cente* fo* Hea't0 Stati"ti(" ge"tationa' 0y!e*ten"ion a" identified in 1$----

oen o* 3.) !e*(ent of !*egnan(ie" 5%a*tin and (o''eag4e" 2--26. I!o*tant'y

7e*g and (o''eag4e" 52--36 *e!o*ted t0at a'o"t 1& !e*(ent of 32-1 !*egnan(y8

*e'ated deat0" in t0e United State" f*o 1991 to 199) e*e f*o (o!'i(ation" of

!*egnan(y8*e'ated 0y!e*ten"ion. T0e"e in/e"tigato*" a'"o fo4nd t0at 'a(: oen

in t0i" (o4nt*y a*e 3.1 tie" a" 'i:e'y to die f*o !*ee('a!"ia a" 0ite oen.

T0e te*gestational hypertensioni" 4"ed no to de"(*ie any fo* of ne8on"et

!*egnan(y8*e'ated 0y!e*ten"ion. It a" ado!ted y t0e Wo*:ing ;*o4! of t0e

NH7PEP 52---6 0i(0 !*o!o"ed a ('a""ifi(ation "y"te a"ed on ('ini(a'

"i!'i(ity to g4ide anageent. T0e te* a" (0o"en to e!0a"i


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1. ;e"tationa' 0y!e*ten"ion 5fo*e*'y !*egnan(y8ind4(ed 0y!e*ten"ion t0at

in('4ded t*an"ient 0y!e*ten"ion6.2. P*ee('a!"ia.

3. E('a!"ia.

#. P*ee('a!"ia "4!e*i!o"ed on (0*oni( 0y!e*ten"ion.

$. C0*oni( 0y!e*ten"ion.

P*e8e('a!"ia i" a 4'ti8"y"te "ynd*oe 4ni=4e to !*egnan(y (0a*a(te*i


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Ce"a*ean de'i/e*ie" and t0o"e !e*fo*ed fo* dy"to(ia 0a/e een t0e 'eading

indi(ation" in ot0 t0e United State" and ot0e* e"te*n ind4"t*ia'i


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P'a(enta a(*eta

A*4!tion

2.$ %anageent

7a"i( anageent oFe(ti/e" fo* any !*egnan(y (o!'i(ated y !*ee('a!"ia a*e?

1. Te*ination of !*egnan(y it0 t0e 'ea"t !o""i'e t*a4a to ot0e* and

fet4".

2. 7i*t0 of an infant 0o "4"e=4ent'y t0*i/e".

3. Co!'ete *e"to*ation of 0ea't0 to t0e ot0e*.

In (e*tain oen it0 !*ee('a!"ia e"!e(ia''y t0o"e at o* nea* te* a'' t0*ee

oFe(ti/e" a*e "e*/ed e=4a''y e'' y ind4(tion of 'ao*. T0e*efo*e t0e o"t

i!o*tant info*ation t0at t0e o"tet*i(ian 0a" fo* "4((e""f4' anageent of

!*egnan(y and e"!e(ia''y a !*egnan(y t0at e(oe" (o!'i(ated y 0y!e*ten"ion

i" !*e(i"e :no'edge of t0e age of t0e fet4". 5C4nning0a ; Ha4t0 C Le/eno

et a'. Wi''ia" o"tet*i(" 22t0 ed ? Hy!e*ten"i/e Di"o*de*" in P*egnan(y.

%(;*a Hi'' Ne ,o*: 2--$. !)&18+-)6

Early Prena%al 2e%e8%ion

T*aditiona''y t0e f*e=4en(y of !*enata' /i"it" i" in(*ea"ed d4*ing t0e t0i*d

t*ie"te* to fa(i'itate ea*'y dete(tion of !*ee('a!"ia. Woen it0 o/e*t

0y!e*ten"ion 51#-9- Hg o* g*eate*6 a*e f*e=4ent'y aditted to t0e 0o"!ita'

fo* 2 to 3 day" to e/a'4ate t0e "e/e*ity of ne8on"et 0y!e*ten"ion. Woen it0

!e*"i"tent "e/e*e di"ea"e a*e o"e*/ed ('o"e'y and any a*e de'i/e*ed.

Con/e*"e'y oen it0 i'd di"ea"e a*e often anaged a" o4t!atient".

%anageent of oen it0o4t o/e*t 0y!e*ten"ion 4t in 0o ea*'y

!*ee('a!"ia i" "4"!e(ted d4*ing *o4tine !*enata' /i"it" (on"i"t" !*ia*i'y of

in(*ea"ed "4*/ei''an(e. T0e !*oto(o' 4"ed "4((e""f4''y fo* any yea*" at Pa*:'and

Ho"!ita' in oen it0 ne8on"et dia"to'i( 'ood !*e""4*e *eading" eteen +1

and +9 Hg o* "4dden ano*a' eig0t gain 5o*e t0an 2 !o4nd" !e* ee:


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d4*ing t0e t0i*d t*ie"te*6 in('4de" *et4*n /i"it" at 38 to #8day inte*/a'". S4(0

o4t!atient "4*/ei''an(e i" (ontin4ed 4n'e"" o/e*t 0y!e*ten"ion !*otein4*ia /i"4a'

di"t4*an(e" o* e!iga"t*i( di"(ofo*t "4!e*/ene.

An%e#ar%u9 Hos#i%al Mana'e9en%

Ho"!ita'i


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oino4" "ign. Se/e*e !*ee('a!"ia deand" anti(on/4'"ant and 4"4a''y

anti0y!e*ten"i/e t0e*a!y fo''oed y de'i/e*y. T*eatent i" identi(a' to t0at

de"(*ied "4"e=4ent'y fo* e('a!"ia. T0e !*ie oFe(ti/e" a*e to fo*e"ta''

(on/4'"ion" to !*e/ent int*a(*ania' 0eo**0age and "e*io4" daage to ot0e* /ita'

o*gan" and to de'i/e* a 0ea't0y infant.

Wit0 ode*ate o* "e/e*e !*ee('a!"ia t0at doe" not i!*o/e afte* 0o"!ita'i


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T0e 4"e of angioten"in8(on/e*ting en


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1. ;i/e #8 to &8g 'oading do"e of agne"i4 "4'fate di'4ted in 1-- L of IV

f'4id adini"te*ed o/e* 1$G2- in.

2. 7egin 2 g0* in 1-- L of IV aintenan(e inf4"ion.3. %ea"4*e "e*4 agne"i4 'e/e' at #G& 0* and adF4"t inf4"ion to aintain

'e/e'" eteen #G) E=L 5#.+G+.# dL6.

#. %agne"i4 "4'fate i" di"(ontin4ed 2# 0* afte* de'i/e*y.

In%er9i%%en% In%ra9us8ular In;e8%ions

1. ;i/e # g of agne"i4 "4'fate 5%gSO# )H2O USP6 a" a 2- "o'4tion

int*a/eno4"'y at a *ate not to e@(eed 1 gin.

2. o''o !*o!t'y it0 1- g of $- agne"i4 "4'fate "o'4tion one80a'f 5$

g6 inFe(ted dee!'y in t0e 4!!e* o4te* =4ad*ant of ot0 4tto(:" t0*o4g0 a 38

in(08'ong 2-8ga4ge need'e. 5Addition of 1.- L of 2'ido(aine inii


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DISCUSSION

P*ee('a!"ia a((o4nted fo* 3.1 of !*e'ao* (e"a*ean" and 1.2 of 'ao*ing

(e"a*ean" in 1 'a*ge US (o0o*t.Hoe/e* !*ee('a!"ia a'one in gene*a' i" not an

a!!*o!*iate indi(ation fo* (e"a*ean de'i/e*y a" $- of !atient" it0 "e/e*e

!*ee('a!"ia efo*e 3# ee:" and 1 in 3 efo*e 2+ ee: i'' "4((e""f4''y de'i/e*

/agina''y. Ra!id'y o*"ening !*ee('a!"ia 5eg !*og*e""i/e a(4te *ena' fai'4*e6

*eote f*o de'i/e*y i" ad/an(ed a" an indi(ation fo* (e"a*ean 4t t0i" ('ini(a'

"it4ation i" e@(eeding'y *a*e and t0e*e a*e fe data to "4gge"t t0at o4t(oe" a*e

ette* (o!a*ed it0 aiting 2#8#+ 0o4*" fo* /agina' de'i/e*y. 5T0e/enet AN

W0en i" !*ia*y (e"a*ean. A!!*o!*iate? ate*na' and o"tet*i(a' indi(ation".

SeinPe*inato'. E'"e/ie* 2-12. !32#82)6

T0e de'i/e*y "0o4'd e e'' !'anned done on t0e e"t day !e*fo*ed in t0e e"t

!'a(e y t0e e"t *o4te and it0 t0e e"t "4!!o*t tea. Tiing affe(t" t0e

o4t(oe fo* ot0 ot0e* and ay. If t0e ot0e* i" 4n"ta'e t0en de'i/e*y i"

ina!!*o!*iate and in(*ea"e" *i":. On(e "tai'i"ed it0 anti0y!e*ten"i/e and

!o""i'y anti(on/4'"ant d*4g" t0en a de(i"ion "0o4'd e ade. In t0e a"en(e of

(on/4'"ion" !*o'onging t0e !*egnan(y ay e !o""i'e to i!*o/e t0e o4t(oe

of a !*eat4*e fet4" 4t on'y if t0e ot0e* *eain" "ta'e. Contin4ed ('o"e

onito*ing of ot0e* and ay i" needed. It "ee" idea' to a(0ie/e de'i/e*y

!a*ti(4'a*'y of !*eat4*e infant" d4*ing no*a' o*:ing 0o4*".


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o* !*egnan(ie" 'e"" t0an 3# ee:" ge"tation "te*oid" "0o4'd e gi/en. T0e

enefit" of "te*oid adini"t*ation to t0e fet4" !ea: eteen #+ 0o4*" and & day".

Hoe/e* e/en if de'i/e*y i" !'anned fo* it0in 2# 0o4*" "te*oid" ay "ti'' e of

enefit and "0o4'd e gi/en. Afte* #+ 0o4*" f4*t0e* (on"ide*ation "0o4'd e gi/en

to de'i/e*y a" f4*t0e* de'ay ay not e ad/antageo4" to t0e ay o* ot0e*. In a''

"it4ation" a !'anned e'e(ti/e de'i/e*y "4iting a'' !*ofe""iona'" i" a!!*o!*iate.

T0e ode of de'i/e*y "0o4'd e di"(4""ed it0 t0e (on"4'tant o"tet*i(ian. If

ge"tation i" 4nde* 3# ee:" ind4(tion of 'ao4* i" 4n'i:e'y to e "4((e""f4' and

(on"ide*ation "0o4'd e gi/en to de'i/e*y y Cae"a*ean "e(tion. Afte* 3# ee:"

ge"tation /agina' de'i/e*y "0o4'd e (on"ide*ed in a (e!0a'i( !*e"entation.

Vagina' !*o"tag'andin" i'' in(*ea"e t0e (0an(e of "4((e"". Anti 0y!e*ten"i/e

t*eatent "0o4'd e (ontin4ed t0*o4g0o4t a""e""ent and 'ao4*. In (a"e" 0e*e

de'i/e*y doe" not o((4* /agina''y it0in 1282# 0o4*" t0e ode of de'i/e*y "0o4'd

e *e(on"ide*ed y a "enio* o"tet*i(ian. In (a"e" of "e/e*e !*e8e('a!"ia e/en

0en t0e ay 0a" died o* i" not /ia'e it ay e a!!*o!*iate to e@!edite de'i/e*y

y (ae"a*ean "e(tion in t0e ot0e* " inte*e"t" if ind4(tion of 'ao4* i" !*o'onged.

If 'ood !*e""4*e i" (ont*o''ed 51$-+-81-- Hg6 t0e "e(ond "tage "0o4'd not

e 'iited *o4tine'y. An e!id4*a' i'' no*a''y e 4"ed. T0e t0i*d "tage "0o4'd e

anaged it0 $ 4nit" of i./. "ynto(inon note*goet*ine o* "yntoet*ine.

5T0e Diagno"i" and %anageent of P*e8e('a!"ia and E('a!"ia. C'in P*a(t

;4ide'ine? In"tit4te of O"tet*i(ian" and ;ynae(o'ogi"t" Roya' Co''ege of

P0y"i(ian" of I*e'and. 2-136

In t0e ot0e* 'ite*at4*e ode of te*ination de!ended on !e*iod of ge"tation

fa/o4*ai'ity of (e*/i@ and 4*gen(y of te*ination. Ce*/i(a' !*iing agent" 'i:e


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P;E2 ge' o* P;E1e*e ide'y 4"ed if t0e (e*/i@ a" fo4nd 4nfa/o4*a'e. Lao*

a" a((e'e*ated y a*tifi(ia' *4!t4*e of e*ane" and "ynto(inon 0ene/e*

ne(e""a*y. Cae"a*ean "e(tion a" !e*fo*ed fo* o"tet*i( indi(ation" and 0en

4*gent te*ination a" indi(ated fo* 4nfa/o4*a'e (e*/i@ fai'4*e of ind4(tion and

feta' di"t*e"". T0e d4*ation of 'ao* ode of de'i/e*y and indi(ation fo* de'i/e*y

a" noted.5P*ade"0 A. Ri": fa(to*" fo* !*ee('a!"ia and it" !e*inata' o4t(oe.

T0e S0adan In"tit4te of %edi(a' S(ien(e" Ann 7io Re" 2-13 !18$.6

Indi(ation" of (e"a*ean "e(tion in "e/e*e !*ee('a!"ia

Indi(ation" of (e"a*ean

"e(tion

Tota' ! Va'4e Signifi(an(e

Se/e*e !*ee('a!"ia +1 5#&+6 -2$# Not Signifi(ant

eta' di"t*e"" 3# 519)6 --3$ Si'nifi8an%

Unfa/o4*a'e (e*/i@ & 53$6 -9#3 Not Signifi(ant

Le"" feta' o/eent 1- 5$+6 -)2- Not Signifi(ant

Cont*a(ted !e'/i" 9 5$26 -& Not Signifi(ant

Po"t (e"a*ea "e(tion 1) 59+6 -1-# Not Signifi(ant

IU;Ro'igo0yd*anion

"

) 5#6 -919 Not Signifi(ant

Ind4(tion" fai'4*e # 5236 -&&& Not Signifi(ant

P*eat4*e *4!t4*e of

e*ane

3 51+6 -1$# Not Signifi(ant

Hig0 f'oating 0ead 2 5126 -1$# Not Signifi(ant


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O"t*4(ted 'ao4* 1 5-&6 -31& Not Signifi(ant

Of t0e 1)3 !atient" of "e/e*e !*ee('a!"ia 4nde*going ee*gen(y (e"a*ean

"e(tion 1#& 5+#.$6 !atient" e*e adini"te*ed "!ina' ane"t0e"ia 5SA6 and 2)

51$.$6 !atient" *e(ei/ed gene*a' ane"t0e"ia 5;A6 in o4* "t4dy a" !e* (0oi(e of

ane"t0e"io'ogi"t" (on(e*ned. Of t0e /a*io4" indi(ation" a /e*y 0ig0 !e*(entage of

!atient" 4nde*ent ;A d4e to feta' di"t*e"" 53) /e*"4" 1&.# J -.-$6. A''

ot0e* indi(ation" fo* (e"a*ean "e(tione*e "ii'a* in8eteen t0e!atient" 0o

4nde*ent "!ina' and gene*a' ane"t0e"ia. C0atto!ad0yay S Da" A Pa0a*i S.

C'ini(a' "t4dy? etoate*na' o4t(oe in "e/e*e !*ee('a!ti( oen 4nde*going

ee*gen(y (e"a*ean "e(tion 4nde* eit0e* gene*a' o* "!ina' ane"t0e"ia. o4*na' of

P*egnan(y India 2-1# !1811

Anti0y!e*ten"i/e and anti"ei

Risk Factors for Caesarean Section With Severe Pre Eclampsia

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