Dita Puspita Trianti

Midwifery Care Plan (Severe Preeklampsia)

Indonesia

Pre eklamsia Berat

Ditinjau dari umur kehamilan dan perkembangan gejala-gejala preeklamsia berat selama

perawatan maka perawatan dibagi menjadi : 1). Perawatan aktif yaitu kehamilan segera diakhiri

atau diterminasi ditambah pengobatan medicinal; 2) Perawatan konservatif yaitu kehamilan tetap

dipertahankan ditambah pengobatan medicinal.

1) Perawatan aktif, sedapat mungkin sebelum perawatan aktif pada setiap penderita dilakukan

pemeriksaan fetal assessment yakni pemeriksaan non stress test (NST) dan ultrasonografi (USG)

dengan indikasi salah satu atau lebih yakni :

a) Ibu: Usia kehamilan 37 minggu atau lebih, adanya tanda – tanda impending eklamsia, kegagalan

terapi konserfatif yaitu setelah 6 jam pengobatan meditasi terjadi kenaikan desakan tekanan darah

atau setelah 24 jam perawatan medicinal, ada gejala – gejala status quo (tidak ada perbaikan)

b) Janin: Hasil fetal assasemen jelek (NST dan USG) adanya tanda IUGR

c) Hasil laboratorium: Adanya HELLP syndrome

2) Pengobatan medisinal pasien PEB dilakukan di RS dan atas instruksi dokter yaitu segera masuk

RS, tirah baring miring ke satu sisi. Tanda vital diperiksa setiap 30 menit, reflek patela setiap jam,

infus dextrose 5% dimana setiap 1 liter diselingi dengan infus RL (60 – 125 cc/jam) 500cc berikan

antasida : diet cukup protein, rendah karbohidrat lemak dan garam, pemberian obat anti kejang
 MgSO4 diuretikum tidak diberikan kecuali bila ada tanda – tanda edema paru, payah

jantungkongestif atau edema anasarka. Diberikan furosemid injeksi 40 mg/IM.

3) Antihapertensi diberikan bila tekanan darah sistolis lebih 180 mmHg (diastol lebih 110 mmHg

atau MAP lebih 125 mmHg sasaran pengobatan adalah tekanan diastolis kurang 105 mmHg bukan

kurang 90 mmHg karena akan menurunkan perfusi plasenta dosis antihipertensi sama dengan dosis

antihipertensi pada umumnya.

4) Bila dibutuhkan penurunan tekanan darah secepatnya diberikan obat–obat antihipertensi

parenteral (tetesan kontinyu) catapres injeksi. Dosis yang biasa dipakai 5 ampul dalam 500 cc

cairan infus atau pres disesuaikan dengan tekanan darah.

5) Bila tidak tersedia antihipertensi parenteral dapat di berikan tablet anti hipertensi secara

sublingual diulang selang 1 jam maksimal 4 – 5 kali. Bersama dengan awal pemberian sublingual

maka obat yang sama mulai diberikan secara oral.

6) Pengobatan jantung jika ada indikasinya yakni ada tanda – tanda menjurus payah jantung

diberikan digitalisasi cepat dengan cedilanid D.

7) Lain – lain : Konsul penyakit dalam/jantung, mata, obat – obat anti piretik diberikan bila suhu

rectal 38,5ºC dapat dibantu dengan pemberian kompres dingin atau alkohol atau xylomidon 2 cc

IM, antibiotik diberikan atas indikasi. Diberikan ampicilin 1 gr/ 6 jam/ IV/hari, anti nyeri bila

penderita kesakitan atau gelisah karena kontraksi uterus dapat diberikan petidin HCL 50 – 75 mg

sekali saja, selambat lambatnya 2 jam sebelum janin lahir.

Bahasa Inggris

Severe Preeklampsia

Judging from the age of pregnancy and the development of severe symptoms of preeclampsia

during treatment, treatment is divided into: 1). Active treatment, namely pregnancy immediately

terminated or terminated plus medicinal treatment; 2) Conservative treatment that is pregnancy is

maintained plus medicinal treatment.

1) Active treatment, as far as possible before active treatment in each patient, fetal assessment is

carried out, namely non stress test (NST) and ultrasonography (USG) examination with indications

of one or more, namely:

a) Mother: 37 weeks or more of gestational age, signs of impending eclampsia, failure of

conservative therapy ie after 6 hours of meditation treatment there is an increase in blood pressure

pressure or after 24 hours of medicinal treatment, there are symptoms of status quo (no

improvement)

b) Fetus: Bad fetal assay results (NST and USG) presence of an IUGR sign

c) Laboratory results: The presence of HELLP syndrome

2) Medicinal treatment for PEB patients is carried out at the hospital and at the doctor's instructions

that is immediately to the hospital, bed rest is tilted to one side. Vital signs are examined every 30

minutes, patellar reflexes every hour, 5% dextrose infusion where every 1 liter is interspersed with

RL infusion (60 - 125 cc / hour) 500cc give antacids: sufficient protein diet, low carbohydrate fat

and salt, anti-seizure medication MgSO4 diuretics are not given unless there are signs of

pulmonary edema, poor heart failure or anasarka edema. Furosemide was given 40 mg / IM

injection.
3) Antihypertension is given if the systolic blood pressure is more than 180 mmHg (diastole is

more than 110 mmHg or MAP is more than 125 mmHg. The treatment target is diastolic pressure

less than 105 mmHg not less than 90 mmHg because it will reduce placental perfusion at the same

dose as antihypertensive dose.

4) If blood pressure reduction is needed immediately, parenteral antihypertensive drugs

(continuous drops) of injection catapres are given. The usual dosage is 5 ampoules in 500 cc of

infusion or pres adjusted according to blood pressure.

5) If parenteral antihypertension is not available, antihypertensive tablets can be given sublingually

repeated at a maximum of 1 hour 4-5 times. Together with the start of sublingual administration,

the same drug starts orally.

6) Treatment of the heart if there are indications that there are signs that lead to poor heart given

rapid digitization with cedilanid D.

7) Others: Consul for internal diseases / heart, eyes, anti-pyretic drugs given if rectal temperature

of 38.5ºC can be helped by giving cold compresses or alcohol or xylomidone 2 cc IM, antibiotics

are given for indications. Given ampicilin 1 gr / 6 hours / IV / day, anti-pain if the patient is in pain

or restless because uterine contractions can be given petidine HCL 50-75 mg once, no later than 2

hours before the fetus is born.