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

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

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 involusimobilisasi cairan ekstra vaskuler ; Mitral stenosis Edema paru

4.Hipercoagulability : thromboemboli,artificial heart valve

5.Peningkatan tinggi Cardiac output :aorta stenosis,hpp

TUJUAN UTAMA prenatal care adalah identifikasi dini :

1.ibu dengan naikya risikokomplikasi medis,dllkomplikasi kehamilan, komplikasi janin (abnormal).

2. ada kesempatan untukmendiskusikan masalah2 tersebutsampai rencana management dan intervensi

3. Yang ideal : mulaipremarriage counsellingpreconception counsellingprenatal care

Intinya adalah screening dan case finding

TUJUAN GUIDIELINE1.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 2013Guideline 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 GUIDELINEdidasari bersamaan high-quality evidence dan a strong recommendation. Berarti ada ruang untuk clinical judhgment dokter untuk individualiusasi manajemanpada pasien tertentu

THERE IS NO AUTHORITY IN SCIENCE

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JANGAN TERKECOH Kebijaakan,Pedoman,panduan,spo.Bukan Standar.

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 studies2. 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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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 pregnanciesc.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 preeclampsia2. 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’ gestation2.preeclampsia with severe features: by 34 weeks3.chronic hypertension: not before 38 weeks4.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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