Nulliparous Women with preeclampsia syndrome and Intrauterine Growth Restriction

(IUGR) and outcome baby with Necrotizing enterocolitis (NEC)

Ferry Iskandar K.S, Dovy Djanas, Eni Yantri
Fetomaternal Subdivision, Departement of Obstetrics and Gynecology
Medical Faculty of Andalas University
Dr. M. Djamil Central General Hospital
Abstract

Abstrak

Objective : To report a case nulliparous women with

preeclampsia syndrome and Intrauterine Growth
Restriction (IUGR) and outcome baby with Necrotizing
enterocolitis (NEC)
Methods : Case Report
Result:
Reported cases of women aged 27 years old with a
diagnose G1P0A0L0 preterm pregnancy 31-32 weeks +
preeclampsia syndrome + intrauterine growth restriction
(IUGR), intrauterine single live fetus. Patients treated
with the aim ekspektatif management and lung
maturation. Second Day, there was fetal distress and
carried out by emergency caesarean section delivery. Born
baby boy, 1150 grams in weight, 35 cm in length, A/S:
7/9. The mother was treated for 3 days and come home in
good condition. Infants treated in perinatolgy department
for 98 days with a diagnose neonate very low birth weight
1150 grams, necrotizing enterocolitis (NEC), sepsis and
jaundice. Third day, the patient's family requested that her
baby be breastfed 6x2cc /day breast milk. 2 days after
that, the baby's stomach distension and radiological
examination with NEC impression. Infants treated with
NEC management. Nineth day, infants showed
improvement, but the family still breastfeeding exceed
recommended doctors and since then it happened
deterioration in infants. Worsening NEC, sepsis and
jaundice. Baby home in a good condition with 1300
grams in weight, good suction reflexes but easily tired
during breastfeeding so attached nasogastrics tube to
ensure adequate intake.
Conclusion:
Babies who are born preterm with IUGR due to a
preeclampsia syndrome highly at risk of NEC mainly due
to breastfeeding too early and more than doctors
recomended to brestfeed due to breast milk intolerant in
preterm infant.
Keywords:
nulliparous,
preeclampsia
syndrome,
intreuterine growth restriction (IUGR), necrotizing
enterocolitis (NEC), breast milk intolerant

Tujuan : Melaporkan Kasus kehamilan primigravida

dengan sindroma preeklampsia dan pertumbuhan janin
terhambat dengan kejadian necrotizing enterocolitis
Metode : Laporan kasus
Hasil :
Dilaporkan kasus perempuan usia 27 tahun dengan
diagnosis G1P0A0H0 gravid preterm 31-32 minggu +
sindroma preeklamsia + pertumbuhan janin terhambat,
janin hidup tunggal intrauterine. Pasien dirawat dengan
tujuan ekspektatif dan pematangan paru. Hari rawatan ke
dua janin mengalami distress dan dilakukan pelahiran
secara SC Cito. Lahir bayi laki-laki dengan berat badan
1150 gram, panjang badan 35 cm, A/S : 7/9. Ibu dirawat
selama 3 hari dan pulang dalam keadaan baik. Bayi
dirawat di bagian perinatolgi selama 98 hari dengan
diagnosis NBBLSR 1150 gram, necrotizing enterocolitis
(NEC), sepsis dan ikterik. Rawatan hari ke 3 keluarga
pasien meminta agar bayinya diberi ASI 6x2cc/hari. 2
hari setelah itu, perut bayi distensi dan dilakukan
pemeriksaan radiologis dengan kesan NEC. Bayi dirawat
dengan managemen NEC. Rawatan hari ke 9 bayi
menunjukkan perbaikan, akan tetapi keluarga tetap
memberi ASI melebihi anjuran dokter dan sejak saat itu
terjadi perburukan pada bayi. Perburukan NEC, terjadi
sepsis dan ikterik. Bayi pulang dalam keadaan baik
dengan berat badan 1300 gram, reflek hisap baik akan
tetapi bayi mudah lelah pada saat menyusui sehingga
terpasang NGT untuk memenuhi asupan nutrisi
Kesimpulan :
Bayi yang dilahirkan kurang bulan dengan adanya bukti
pertumbuhan janin terhambat akibat suatu sindroma
preeklampsia sangat beresiko terjadinya NEC terutama
akibat pemberian ASI terlalu dini dan
pemberian
melebihi anjuran dimana bayi belum toleran dalam
mencerna ASI
Kata kunci : primigravida, syndroma preeklampsia,
pertumbuhan janin terhambat, necrotizing enterocolitis
(NEC), intoleransi ASI

Correspondence:
1. Ferry Iskandar K.S, Fetomaternal Subdivision, Departement of Obstetrics and Gynecology, Medical
Faculty of Andalas University, Padang. Phone: +628116622888, Email: ferry220187@gmail.com
2. Dovy Djanas, Fetomaternal Subdivision, Departement of Obstetrics and Gynecology, Medical
Faculty of Andalas University, Padang. Phone: +628266194050, Email: dovy.djanas@yahoo.com
3. Eni Yantri, perinatology subdivision, Department of Pediatrics, Medical Faculty of Andalas
University, Padang.