Upload
ozan-irwanadi
View
286
Download
12
Embed Size (px)
DESCRIPTION
obgyn
Citation preview
OBESITAS, DM GESTASIONAL DAN KEHAMILAN
OBESITAS DI NEGERI MAJU BUKAN JEPANG
OVERWEIGHT-BMI 25 29,9OBESITY BMI > 30WANITA > PRIA1/3 ORANG AMERIKA OBESE25 % WANITA AMERIKA OVERWEIGHT, 25 % OBESEMENINGKAT TERUS DALAM 100 TAHUN TERAKHIR-TIDAK BERHASIL DITURUNKAN SEPERTI MMR DI INDONESIAANGKA KEMATIAN PADA OBESE + DM 4 X >+ APPENDICITIS 2 X + KECELAKAAN >
Diabetes MellitusMetabolisme karbohidrat dalam kehamilan Insulin ibu tdk dpt mencapai janinTimbul Resistensi InsulinProduksi rendah, Reseptor rusakMengakibatkan Hipoinsulin IbuTimbullah keadaan Hiperglikemi Diabetes dalam KehamilanTimbul Hiperinsulin Janin
THE PHYSIOLOGIC FEEDBACK LOOPOBESITY ( LEPTIN RESISTANCE)FOOD INTAKEENERGY EXPENDITUREFAT CELLSPANCREASLEPTININSULIN- HYPOTHALAMUS (NPY AND OTHERS)- SYMPATHETIC NERVOUS SYSTEM
PENAPISAN DM GESTASIONALLow RiskBlood glucose testing not routinely required if all of the following characteristics are present :Member of an ethnic group with a low prevalence of gestational diabetesNo known diabetes in first degree relativesAge less than 25 yearsWeight normal before pregnancyNo history of abnormal glucose metabolismNo history of poor obstetrical outcomeAverage RiskPerform blood glucose testing at 24 28 weeks using one of the following :Average risk women of Hispanic, African, Native American, South of East Asian originsHigh risk women with marked obesity, strong family history of type 2 diabetes, prior gestational diabetes, or glucosuriaHigh RiskPerform blood glucose testing as soon as feasible : If gestational diabetes is not diagnosed, blood glucose testing should be repeated at 24 28 weeks or at any time a patient has symptoms or signs suggestive of hyperglycemia
SKRININGWANITA RISIKO TINGGI24-28 MINGGU50 G LOADING GLUKOSA PLASMA > 140 G%DILANJUTKAN DENGAN TTGO U/ DIAGNOSIS
DIAGNOSIS: TTGO100 G BUKAN 75 GGLUKOSA PLASMA PUASA1 JAM2 JAM3 JAM
DIAGNOSIS DM GESTASIONAL
Timing of MeasurementPlasma Glucose ( mg/dL )aNational Diabetes Data Group ( 1979 )Carpenter and Coustan ( 1982 )Fasting105951 hr1901802 hr1651553 hr145140
BATASAN DAN KLASIFIKASI DM GESTASIONAL
GANGGUAN TOLERANSI GLUKOSA BERBAGAI TINGKAT YANG MUNCUL ATAU DIDIAGNOSIS PERTAMA KALI SAAT KEHAMILAN
CLASSONSETFASTING PLASMA GLUCOSE2-HOUR POSTPRANDIAL GLUCOSETHERAPYA1GESTATIONAL< 105 mg/Dl< 120 mg/dLDIETA2GESTATIONAL> 105 mg/dL> 120 mg/dLINSULINCLASSAGE OF ONSET(yr)DURATION (yr)VASCULAR DISEASETHERAPYBOVER 20< 10NONEINSULINC10 19 10 19 NONEINSULINDBEFORE 10> 20BENIGN RETINOPATHYINSULINFANYANYNEPHROPATHYaINSULINRANYANYPROLIFERATIVE RETINOPATHYINSULINHANYANYHEARTINSULIN
Pengaruh terhadap kehamilanPreeklampsiHidramnionKelainan letak janinAbortusPartus Prematurus
Pengaruh terhadap PersalinanInertia uteriDistosia bahuIUFDInfeksi meningkatSC meningkatMMR meningkat
Pengaruh terhadap NifasInfeksi nifasSepsisWound Dehiscene
Pengaruh terhadap JaninCacat BawaanIUFDDismaturitasMakrosomiaKematian NoenatalRDS
PENATALAKSANAAN OBSTETRISBISA SAMPAI ATERM MAKSIMAL 40 MINGGUTIDAK PERLU MENCARI KELAINAN BAWAAN JANINWaspada MAKROSOMIAPERVAGINAM, SC A/I OBSTETRIS
KomplikasiMAKROSOMIA DG SEGALA AKIBATNYA:DISTOSIA BAHU O/K VISEROMEGALITRAUMA PERSALINANJAUNDICESC MENINGKATDM nyata pada ibuObesitas dan DM nyata pada bayi
MAKROSOMIA
Hipertiroid dalam KehamilanMerupakan Hiperfungsi kelenjar Gondok ( Tiroid )Insiden : 0,2 % kehamilanSering mengalami :- Gangguan Haid- Infertilitas
Klinis ExopthalmusTremorBerdebar - debarTakikardiMetabolisme basal meningkatHormon Tiroksin meningkat
DiagnostikAdanya kelenjar gondokKlinisLaboratoris TSHS, T3 dn FT4
PenatalaksanaanMedis- PTU- Lugol- PropanololPersalinan- Pervaginam- SC ai obstetris