Pengantar Pelatihan

WORKSHOP DAN HANDS ON DETEKSI DINI IBU HAMIL

RISIKO TINGGI UNTUK MENINGKATKAN SURVIVAL
MATERNAL NEONATAL

Irwan T Rachman
(email: irwantaufiqurrachman@yahoo.co.id)

Division of Maternal Fetal Medicine

Department of Obstetrics and Gynecology
Sardjito Hospital - Yogyakarta
Maternal Mortality
How about in
Indonesia?
Maternal Mortality Rate per-province
in Indonesia
 Pyramid of Prenatal Care
Pyramid of traditional prenatal
care New pyramid of prenatal care

*The
Ministry of Health in the UK issued a
Memorandum on Antenatal Clinics
Maternal Mortality

Source: Annual death rate per 1000 total births from maternal mortality in England and
Wales (1850–1970) (Registrar General Reports)
Continuing of Care
 Continuing of Care
11-13 20-22 37-38 41
weeks weeks weeks weeks

Low Risk PPK1

PPK2

High Risk
PPK3
Screening for Preeclmpsia
Konsep Hulu – Hilir ANC
Ibu Hamil dengan
faktor risiko

Gestational complication:
- Abortus (habitualis)
- IUGR
- Preeklamsia/ eklamsia
- Gestational Diabetes
- Penyakit jantung dlm
kehamilan
Perkembangan Definisi Preeklamsi

Hipertensi Proteinuria

PE

Edema
PROBLEMS WITH CLASSIFICATION
• Some clinicians
therefore recommend
close observation of
women with an
incremental rise in
blood pressure by 30
mm Hg systolic or 15
mm Hg diastolic even if
absolute blood pressure
does not exceed 140/90
mm Hg
 11-13 20-22 37-38 41
weeks weeks weeks weeks

First Scoring Risiko Preeklamsia

Prenatal

PPK 1
One of the following condition:
Visit 1) hypertensive disease during a
previous pregnancy
2) chronic kidney disease
3) autoimmune disease such as
systemic lupus erythematosis or
antiphospholipid syndrome
4) type 1 or type 2 diabetes

PPK 2
5) chronic hypertension
6) multiple pregnancy
More than one moderate risk factor
for pre-eclampsia
1) first pregnancy
2) age 40 years or older
3) pregnancy interval of more than
10 years
4) body mass index (BMI) of 35

PPK 3
kg/m2 or more at first visit
5) family history of pre-eclampsia
Doppler A. Uterina
Review
Preeklamsia: Tidak lagi semata-mata hanya
penyakit kehamilan

Andrea L. Tranquillia, Beatrice Landia, Stefano R. Giannubiloa,*, Baha M. Sibaib

Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 350-357
Maternal Death Risk of Preeclampsia
 Eclampsia
• Eclampsia is the
occurrence of seizures
that cannot be
attributed to other
causes in a woman with
preeclampsia
How the first nine months shape the rest
of your life

How the First Nine Months Shape the Rest

of Your Life | Oct. 4, 2010
 Fetal Origins of Adult Disease
• Dr. David Barker first popularized the concept of
fetal origins of adult disease (FOAD)/ Barker
hypothesis
• Clues originally arose from large 20th century, European
birth registries
• Beyond the LBW population and include babies exposed
to stress, both nutritional and nonnutritional, during
different critical periods of development
• The FOAD hypothesis holds that events during
early development have a profound impact on
one’s risk for development of future adult
disease
• Today, LBW is associated with a host of chronic
diseases ranging from coronary artery disease (CAD), David Barker, M.D., Ph.D., FRS
type II diabetes mellitus (T2DM), cancer, and
osteoporosis to various psychiatric illnesses
Chronic diseases associated with the fetal
origins of adult disease (FOAD) hypothesis
• Diabetes mellitus Obesity
• Dyslipidemia Hypertension
• Coronary artery disease Stroke
• Kidney failure—glomerulosclerosis
• Liver failure—cholestasis, steatosis
• Lung abnormalities—BPD, reactive airway disease
Immune dysfunction
• Reduced bone mass
• Alzheimer’s disease
• Depression, anxiety, bipolar disorder, schizophrenia
• Cancer
BPJS Defisit Anggaran, Sebagian Besar Karena
Penyakit Tak Menular
Hari I: Jum’at, 16 Maret 2017
Hari II: Sabtu, 17 Maret 2017
TERIMA KASIH