tag:blogger.com,1999:blog-85532964005435938352024-03-08T20:48:52.621+07:00Blog MawarInspirasi buat semua orangblog bidan aie mawarhttp://www.blogger.com/profile/01675794479695431311noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-8553296400543593835.post-74130319814539092052011-11-07T19:34:00.000+07:002011-11-07T19:34:08.361+07:00HIPERTENSI DALAM KEHAMILAN<div dir="ltr" style="text-align: left;" trbidi="on"><div style="color: purple;"><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> </div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><span class="hps"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
</span></b></span><span class="hps"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> Pendahuluan</span></b></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Gangguan</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">hipertensi</span> <span class="hps">kehamilan</span> <span class="hps">tetap menjadi</span> <span class="hps">publik</span> <span class="hps">pusat</span> <span class="hps">keprihatinan</span> <span class="hps">kesehatan</span> <span class="hps">di seluruh dunia</span>, <span class="hps">dan merupakan</span> <span class="hps">penyebab utama</span> <span class="hps">kematian ibu</span><br />
<span class="hps">di negara berkembang</span>. <span class="hps">Walaupun</span> <span class="hps">pilihan pengobatan</span> <span class="hps">belum</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">berubah secara signifikan</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">dalam beberapa tahun terakhir</span>, <span class="hps">wawasan tentang</span> <span class="hps">patogenesis</span> <span class="hps">preeklampsia/ eklampsia</span> <span class="hps">telah luar biasa</span>. <span class="hps">Ada juga</span> <span class="hps">yang berpendapat tentang bagaimana</span> <span class="hps">sulitnya dipahami</span> tentang <span class="hps">diagnosis</span> <span class="hps">eklampsia,</span> <span class="hps">terutama di</span><br />
<span class="hps">periode</span> <span class="hps">postpartum</span>. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Perawatan yang tepat</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">dari</span> <span class="hps">pasien ini</span> <span class="hps">sangat tergantung pada</span> <span class="hps">diagnosis yang benar</span>, <span class="hps">terutama</span> <span class="hps">oleh dokter</span> <span class="hps">darurat</span>. <span class="hps">Akhirnya</span>, <span class="hps">bagian epidemiologi</span> <span class="hps">telah mengungkapkan</span> <span class="hps">bahwa preeklamsia</span>, <span class="hps">pernah dianggap</span> <span class="hps">menjadi</span> <span class="hps">entitas</span> <span class="hps">diri</span> <span class="hps">yang terbatas</span>, <span class="hps">sekarang tampaknya</span> <span class="hps">meramalkan</span> <span class="hps">kerusakan nyata</span> <span class="hps">pada</span> <span class="hps">kardiovaskular</span> <span class="hps">dan sistem organ</span> <span class="hps">lainnya</span> <span class="hps">dalam jangka panjang</span>. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><span class="hps"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Fisiologis</span></b></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">Perubahan</span> <span class="hps">Kehamilan</span> <span class="hps">Normal</span></span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Beberapa adaptasi</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">fisiologis</span> <span class="hps">terjadi selama kehamilan</span> <span class="hps">yang normal</span>. <span class="hps">Ada</span> <span class="hps">ekspansi volume</span> <span class="hps">plasma</span>, penurunan <span class="hps">rata-rata</span> <span class="hps">tekanan arteri dan</span> <span class="hps">resistensi</span> <span class="hps">vaskular</span> <span class="hps">sistemik</span>, <span class="hps">dan peningkatan</span> <span class="hps">output jantung. Turunnya</span> <span class="hps">tekanan</span> <span class="hps">darah biasanya</span> <span class="hps">memuncak di awal trimester</span> <span class="hps">kedua,</span> <span class="hps">dan merupakan</span> <span class="hps">akibat dari</span> <span class="hps">beberapa faktor</span>, termasuk <span class="hps">refractoriness</span> <span class="hps">vaskular</span> <span class="hps">menjadi angiotensin</span> <span class="hps">II</span>, <span class="hps">meningkat</span> <span class="hps">prostasiklin</span> <span class="hps">endotel</span>, <span class="hps">dan</span> produksi <span class="hps">nitrat</span> <span class="hps">oksida</span>. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Jika</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">penurunan tekanan darah</span> <span class="hps">adalah signifikan</span>, mungkin <span class="hps">menghilangkan</span> <span class="hps">diagnosis</span> yang <span class="hps">sudah ada sebelumnya</span> (<span class="hps">Hipertensi ringan),</span> <span class="hps">terutama</span> <span class="hps">pada ibu hamil</span> <span class="hps">yang tidak mengontrol/ mengecek</span> <span class="hps">tekanan darah</span> <span class="hps">sebelum kehamilan</span>. <span class="hps">Selain itu</span>, <span class="hps">plasma dan</span> <span class="hps">volume</span> <span class="hps">sel darah merah</span> <span class="hps">meningkat sebesar 40</span>% <span class="hps">dan 25</span>%, masing-masing <span class="hps">selama</span> <span class="hps">kehamilan</span>. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Perubahan ini</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">dimulai</span> <span class="hps">pada awal</span> <span class="hps">minggu keempat</span> <span class="hps">kehamilan dan</span> <span class="hps">puncaknya sekitar</span> <span class="hps">minggu ke-28</span>. <span class="hps">Kenaikan</span> <span class="hps">dalam massa</span> <span class="hps">sel darah merah</span> <span class="hps">lebih rendah</span> <span class="hps">dibandingkan dengan</span> <span class="hps">kenaikan</span> <span class="hps">volume plasma</span> <span class="hps">yang memberikan kontribusi</span><br />
<span class="hps">untuk</span> <span class="hps">anemia</span> <span class="hps">fisiologis</span> <span class="hps">kehamilan </span>walaupun hanya <span class="hps">30%</span> <span class="hps">sampai 50</span>%. <span class="hps"></span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Gangguan hipertensi merupakan komplikasi yang paling signifikan<br />
dalam kehamilan dan mempengaruhi sekitar 10% dari semua kehamilan. Hipertensi ini berkontribusi besar terhadap kematian maternal dan perinatal di seluruh<br />
dunia. Di banyak negara yang berpenghasilan rendah, komplikasi dari kehamilan<br />
dan persalinan adalah penyebab utama kematian di kalangan perempuan<br />
yang bereproduksi. Hipertensi selama kehamilan disertai dengan peningkatan risiko lepasnya plasenta, koagulasi intravaskular diseminata, perdarahan otak, gagal hati, dan gagal ginjal akut. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Preeklamsia, khususnya dapat merusak dan mengancam nyawa<br />
ibu dan janin. Secara keseluruhan, 10% sampai 15% dari kematian ibu yang berhubungan dengan preeklamsia dan eklampsia. Jumlah ini cenderung lebih tinggi di negara berkembang, hingga 100 kali lebih tinggi di beberapa bagian Afrika dan Asia dibandingkan dengan negara barat. Pengurangan angka kematian ibu sebesar 75% telah ditetapkan sebagai salah satu tujuan pembangunan milenium oleh PBB untuk<br />
dicapai berdasarkan tahun 2015. Dalam beberapa tahun terakhir, telah ada kemajuan penting mengenai patofisiologi, pencegahan, dan pengobatan preeklamsia. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><span style="color: purple;"> </span><b style="color: purple;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-language: AR-SA; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-hansi-theme-font: major-bidi;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" /> </span></b> <div class="MsoNormal" style="color: purple;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Klasifikasi Hipertensi Selama Kehamilan</span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Menurut American College of Obstetri dan Ginekologi, hipertensi selama kehamilan telah diklasifikasikan ke dalam kelompok berikut:</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">1. Hipertensi kronis.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">2. Hipertensi gestational.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">3. Preeklamsia-eklamsia.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">4. Preeklamsia-eklamsia yang dihubungkan pada hipertensi kronis.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Definisi Hipertensi</span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Hipertensi didefinisikan sebagai peningkatan yang berkelanjutan dalam<br />
tekanan darah yaitu 140/90 mm Hg. Beberapa penelitian telah menunjukkan bahwa<br />
hingga 73% dari pasien primipara mengalami peningkatan tekanan diastolik dalam darah yaitu 15 mm Hg di beberapa titik selama kehamilan normotensif tanpa peningkatan outcomes. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Hal ini merugikan namun, disarankan bahwa setiap wanita hamil dengan kenaikan tekanan sistolik dalam darah 30 mm Hg atau tekanan darah diastolik dari 15 mmHg harus dimonitor secara seksama.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="color: purple; line-height: 150%; text-align: justify; text-indent: -0.25in;"><span class="hps"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b></span><span class="hps"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Hipertensi</span></b></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">kronis</span></span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Hipertensi kronis</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">didefinisikan</span> <span class="hps">sebagai tekanan</span> <span class="hps">darah sistolik</span> <span class="hps">dari 140</span> <span class="hps">mm Hg atau</span> <span class="hps">tekanan darah</span> <span class="hps">diastolik</span> <span class="hps">dari 90</span> <span class="hps">mm Hg</span> <span class="hps">sebelum</span> <span class="hps">kehamilan</span> <span class="hps">atau sebelum</span> <span class="hps">20</span> <span class="hps">minggu kehamilan</span>, <span class="hps">atau hipertensi</span> <span class="hps">yang</span> <span class="hps">bertahan selama</span> <span class="hps">lebih dari</span> <span class="hps">12</span> <span class="hps">minggu pasca</span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">melahirkan</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Hipertensi</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">diklasifikasikan</span> <span class="hps">sebagai ringan</span> <span class="hps">ketika tekanan</span> <span class="hps">darah</span> <span class="hps">dalam kisaran, untuk sistolik</span> <span class="hps">140-159</span> <span class="hps">mmHg</span> <span class="hps">dan</span> <span class="hps">90-99</span> <span class="hps">mm Hg</span> untuk <span class="hps">diastolik</span>. <span class="hps">Hipertensi</span> <span class="hps">parah adalah</span> <span class="hps">hipertensi dengan tekanan</span> <span class="hps">darah</span> <span class="hps">160/100</span> <span class="hps">mmHg</span> <span class="hps">dan berkaitan dengan</span> akhir <span class="hps">kerusakan pada organ</span>. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Epidemiologi</span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Diperkirakan bahwa</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">3</span>% dari <span class="hps">wanita hamil</span> <span class="hps">di negara Amerika</span> <span class="hps">mempunyai hipertensi kronis. Prevalensi</span> <span class="hps">hipertensi</span> <span class="hps">secara mencolok</span> <span class="hps">tinggi di antara</span> <span class="hps">perempuan kulit hitam</span> <span class="hps">(44</span>%), serta <span class="hps">perempuan yang lebih tua</span> <span class="hps">(</span>12,6% <span class="hps">sampai</span> <span class="hps">di usia</span> <span class="hps">35 sampai </span>44 tahun).</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><span class="hps"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Penyebab</span></b></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Penyebab utama</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">dari hipertensi</span> <span class="hps">kronis adalah</span> <span class="hps">esensial</span> <span class="hps">hipertensi</span> <span class="hps">atau hipertensi primer (90</span>%), sedangkan <span class="hps">penyebab</span> hipertensi <span class="hps">sekunder</span> <span class="hps">untuk</span> <span class="hps">sisanya</span> <span class="hps">(10</span>%). <span class="hps">Hipertensi sekunder</span> <span class="hps">mungkin karena</span> <span class="hps">penyakit</span> <span class="hps">ginjal</span> <span class="hps">seperti</span> <span class="hps">glomerulonefritis</span>, <span class="hps">stenosis arteri</span> <span class="hps">ginjal</span>, <span class="hps">penyakit pembuluh darah</span> <span class="hps">kolagen</span> <span class="hps">(</span>lupus, <span class="hps">skleroderma</span>), <span class="hps">gangguan</span> <span class="hps">endokrin</span> <span class="hps">atau (</span>tirotoksikosis, <span class="hps">pheochromocytoma</span>, <span class="hps">hiperaldosteronisme</span>).</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Perubahan patofisiologi Hipertensi kronis</span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Tidak seperti adaptasi kehamilan normal, hipertensi kronis di wanita hamil yang ditandai dengan resistensi pembuluh darah tetap tinggi. Indeks resistensi pembuluh darah sistemik hipertensi kronis dan gelombang kecepatan nadi tetap tinggi selama kehamilan dibandingkan dengan seluruh kehamilan yang sehat. Arteri kaku (yang diukur dengan rasio indeks stroke tekanan nadi), bagaimanapun, adalah kurang dalam kronis hipertensi dibandingkan dengan subyek preeklamsi.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Komplikasi Hipertensi kronis</span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Hipertensi kronis pada kehamilan dikaitkan dengan peningkatan kerugian yang terjadi pada ibu dan janin seperti melapis preeklamsia, kematian perinatal, lepasnya plasenta, bayi lahir rendah, pembatasan pertumbuhan berat badan, dan intrauterin (IUGR). Diperkirakan bahwa sekitar 10% sampai 25% dari wanita hamil dengan hipertensi yang sudah ada sebelumnya mengalami preeklamsia.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Dalam sebuah retrospektif besar kohort (penelitian), wanita dengan hipertensi yang sudah ada sebelumnya lebih berisiko preeklamsia berat sebanyak 2,7 kali lipat dibandingkan dengan wanita hamil tanpa hipertensi sebelumnya. Risiko ini bahkan lebih tinggi pada wanita dengan hipertensi yang sudah ada sebelumnya yang parah serta hipertensi yang tidak terkontrol atau pada wanita yang mempunyai penyakit kardiovaskular dan ginjal. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Diagnosis preeklamsia dapat dihubungkan pada pasien hipertensi yang sudah ada dengan proteinuria. Namun, tiba-tiba meningkat menjadi 3 kali lipat peningkatan proteinuria, tekanan darah akut seiring dengan keterlibatan sistem organ lain. Preeklampsi harus dibawah perhatian dokter. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Hipertensi kronis dan proteinuria, terlepas dari pengembangan preeklamsia, terkait dengan sekitar 3-kali lipat peningkatan kejadian prematur pengiriman<br />
(35 minggu kehamilan) dan bayi yang kecil untuk usia kehamilan. Preeklampsia juga pada wanita hamil dikaitkan dengan kejadian lepasnya plasenta dan kematian perinatal yang lebih tinggi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Manajemen Hipertensi Kronis</span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Tekanan darah yang optimal selama kehamilan masih belum diketahui dan tetap kontroversial. Menurut Laporan Ketujuh Bersama Komite Nasional Pencegahan, Deteksi, Evaluasi, dan Pengobatan Tekanan Darah Tinggi (JNC 7) melaporkan, ada linier peningkatan morbiditas kardiovaskular dari tingkat tekanan darah rendah yaitu 115 mm Hg untuk sistolik dan diastolik 75 mm Hg ke atas. <span style="mso-spacerun: yes;"> </span>Ini telah dimasukan oleh 7 JNC dalam klasifikasi baru prehipertensi untuk tekanan darah dalam kisaran 120-139/80-89 mmHg. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Tujuan mengobati hipertensi adalah untuk mengurangi morbiditas kardiovaskular, namun efek yang paling diamati pada pengobatan yaitu<br />
mencapai pengurangan berkelanjutan dalam tekanan darah lebih dari 10 tahun. Wanita hamil dengan hipertensi ringan berbeda, bahwa manfaat pengobatan antihipertensi jangka pendek tidak mendefinisikan dengan baik sebagai hasil potensial yang merugikan terhadap janin.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Tidak ada bukti yang meyakinkan pengobatan medis untuk hipertensi ringan<br />
meningkatkan hasil ibu pada kehamilan. Selain itu, penggunaan obat-obatan<br />
pada hipertensi ringan selama kehamilan dapat menyebabkan penurunan<br />
yaitu adanya tekanan arteri dengan peningkatan risiko janin yang membatasi<br />
pertumbuhan, terlepas dari jenis antihipertensi yang digunakan.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Dengan demikian, rekomendasi saat ini adalah bahwa obat antihipertensi<br />
dimulai sebelum kehamilan harus disesuaikan dengan darah yang memadai untuk </span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">mengontrol tekanan</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> darah <span class="hps">dan untuk menghindari</span> <span class="hps">risiko</span> <span class="hps">teratogenik</span>. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Wanita hamil</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">dengan</span> <span class="hps">hipertensi ringan</span> <span class="hps">(</span>159/99 <span class="hps">mm Hg</span>) <span class="hps">dan bukan pada</span><br />
<span class="hps">obat-obatan harus</span> <span class="hps">tetap diamati</span>, obat <span class="hps">tidak boleh</span> <span class="hps">dimulai</span> <span class="hps">kecuali</span> <span class="hps">tekanan darah</span> <span class="hps">159/99</span> <span class="hps">mm Hg</span> <span class="hps">berlanjut</span>, atau <span class="hps">ada kejadian kerusakan organ. Pemantauan tekanan darah</span> <span class="hps">yang intensif dan</span> <span class="hps">pengobatan</span> <span class="hps">antihipertensi</span> <span class="hps">dalam kasus ini</span> <span class="hps">adalah untuk</span> <span class="hps">mengurangi</span> <span class="hps">risiko</span> <span class="hps">kecelakaan ke</span> <span class="hps">pembuluh darah di otak</span>.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="color: purple; line-height: 150%; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><span class="hps"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Hipertensi</span></b></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">gestasional</span></span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Hipertensi</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">kehamilan</span> ini <span class="hps">berlaku untuk wanita</span> <span class="hps">sudah memasuki trimester dua kehamilan</span>, <span class="hps">dengan tidak adanya</span> <span class="hps">proteinuria</span>. <span class="hps">Ini mungkin termasuk</span> <span class="hps">pasien</span> <span class="hps">yang kemudian</span> <span class="hps">berkembang menjadi</span> <span class="hps">preeklamsia</span>, <span class="hps">tetapi</span> <span class="hps">yang pada</span> <span class="hps">saat di diagnosis</span> <span class="hps">belum</span> <span class="hps">ada</span> <span class="hps">proteinuria</span>. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Kejadian ini</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">biasanya mempengaruhi</span> <span class="hps">wanita</span> dalam <span class="hps">waktu dekat</span>, meskipun <span class="hps">hipertensi yang bentuknya parah</span> <span class="hps">yang timbul</span> <span class="hps">sebelumnya.</span> <span class="hps">Ketika hal ini</span> <span class="hps">terjadi</span>, <span class="hps">preeklamsia</span> <span class="hps">biasanya mengikuti</span> <span class="hps">segera</span>. <span class="hps">Etiologi</span> <span class="hps">hipertensi</span> <span class="hps">kehamilan</span> <span class="hps">adalah</span><br />
<span class="hps">tidak jelas</span>, <span class="hps">meskipun tampaknya</span> <span class="hps">untuk mengidentifikasi wanita</span> <span class="hps">ditakdirkan</span> <span class="hps">untuk mengembangkan hipertensi esensial</span> <span class="hps">di kehidupan nanti.</span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Tekanan darah</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">kembali ke</span> <span class="hps">normal segera</span> <span class="hps">setelah melahirkan</span>, <span class="hps">tetapi kekambuhan</span> <span class="hps">mungkin terjadi pada</span> <span class="hps">kehamilan berikutnya</span>. <span class="hps">Sering</span> <span class="hps">kali</span> <span class="hps">diagnosis hipertensi</span> <span class="hps">gestasional</span> <span class="hps">yang benar</span> <span class="hps">hanya dapat</span> <span class="hps">dilakukan</span> <span class="hps">setelah melahirkan</span>, <span class="hps">ketika jelas</span> <span class="hps">bahwa pasien</span> <span class="hps">tidak</span> <span class="hps">dikembangkan</span> <span class="hps">preeklamsia</span>. <span class="hps">Dan jika</span> <span class="hps">pasien</span> <span class="hps">hipertensi</span> <span class="hps">berlanjut,</span> <span class="hps">dia</span> <span class="hps">dianggap telah</span> <span class="hps">hipertensi kronis.</span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><br />
</div><div class="MsoListParagraph" style="color: purple; line-height: 150%; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Hipertensi Akhir Postpartum </span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Hipertensi akhir postpartum adalah sebuah kejadian yang tidak biasa yang menggambarkan wanita dengan kehamilan normotensif yang mengembangkan hipertensi beberapa minggu sampai beberapa bulan setelah melahirkan. Hal ini jarang dan menyelesaikan pada akhir dari year postpartum pertama. Sedikit yang diketahui tentang patofisiologi, kecuali bahwa hal itu juga dapat memprediksi penting hipertensi di kemudian hari.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><br />
</div><div class="MsoListParagraph" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Preeklamsia-Eklampsia </span></b><b><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Preeklamsia adalah penyakit eksklusif </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">kehamilan. Hal ini </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">ditandai oleh </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">serangan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">hipertensi dan proteinuria, biasanya setelah 20 minggu kehamilan, dan umumnya berhubungan dengan edema,</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">hiperurisemia, dan proteinuria. Ini mempengaruhi sekitar 5% dari seluruh kehamilan, </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">dan sekitar dua kali lebih umum pada kehamilan pertama sebagai dalam multigravidas. Namun, i</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">tu</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"> adalah umum pada multigravida yang telah mitra baru, menunjukkan bahwa paparan sebelum antigen paternal mungkin protective.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"> <span lang="IN"></span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Sindrom ibu preeklampsia ditandai dengan tekanan darah, proteinuria, dan kerusakan </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">yang </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">berbeda </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">sistem organ termasuk hati, ginjal, otak, jantung, dan paru-paru. Spektrum penyakit dapat bervariasi dari kasus ringan dengan sedikit keterlibatan sistemik (preeklampsia ringan) untuk kegagalan multiorgan (preeklamsia berat). </span><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Pada sekitar 30% dari kasus, penyakit ini dapat menyebabkan <span style="background: white;"><br />
</span>insufisiensi plasenta cukup untuk menyebabkan IUGR atau kematian janin<span style="background: white;">. </span>Ketika serangan kejang terjadi dalam pengaturan preeklamsia, itu disebut eklampsia. Eklampsia kejang dapat terjadi pada antepartum, intrapartum, langsung di masa nifas, atau setelah terlambat melahirkan (48 jam untuk 1 bulan kemudian). Anehnya, itu juga bisa terjadi pada wanita yang tidak memiliki riwayat preeklamsia (sampai satu pertiga).</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><span class="hps"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Patogenesis</span></b></span><span class="longtext"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></b></span><span class="hps"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Preeklampsia</span></b></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Cacat</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">remodelling</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">arteri spiralis</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">pada saat</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">invasi trofoblas</span><span class="longtext"> </span><span class="hps">adalah</span><span class="longtext"> </span><span class="hps">faktor predisposisi</span><span class="longtext"> </span><span class="hps">yang paling dikenal luas</span> <span class="hps">untuk</span><span class="longtext"> </span><span class="hps">preeklamsia.</span><span class="longtext"> </span><span class="hps">Jauh sebelum</span><span class="longtext"> </span><span class="hps">munculnya</span><span class="longtext"> </span><span class="hps">klinis</span>, <span class="hps">preeklamsia,</span><span class="longtext"> </span><span class="hps">imunologi</span><span class="longtext"> </span><span class="hps">dimediasi</span><span class="longtext"> </span><span class="hps">trofoblas</span><span class="longtext"> </span><span class="hps">yang abnormal</span> <span class="hps">invasi</span><span class="longtext"> </span><span class="hps">menyebabkan</span><span class="longtext"> </span><span class="hps">pembentukan</span><span class="longtext"> </span><span class="hps">plasenta</span><span class="longtext"> </span><span class="hps">di mana</span><span class="longtext"> </span><span class="hps">spiral</span><span class="longtext"> </span><span class="hps">rahim</span> <span class="hps">arteri</span><span class="longtext"> </span><span class="hps">gagal untuk</span><span class="longtext"> </span><span class="hps">menjalani</span><span class="longtext"> </span><span class="hps">dinding</span><span class="longtext"> </span><span class="hps">otot</span> yang <span class="hps">menipis secara normal</span><span class="longtext"> </span><span class="hps">yang memungkinkan</span><span class="longtext"> terjadi </span><span class="hps">peningkatan</span><span class="longtext"> </span><span class="hps">perfusi</span><span class="longtext"> </span><span class="hps">plasenta</span><span class="longtext">. </span><span class="hps">Sebagai</span><span class="longtext"> </span><span class="hps">perfusi</span><span class="longtext">, hasilnya</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">ruang intervili terganggu, menyebabkan hipoksia plasenta. </span></span><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Plasenta dari kehamilan preeklamsia dengan maju sering memiliki </span></span><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="longtext">banyak plasenta infarcts dan penyempitan arteriola skleroti</span></span><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">k. </span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Faktor predisposisi untuk preeklampsia adalah </span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">sebelum </span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">ada hipertensi, <span style="background: white;">penyakit ginjal kronis, obesitas, diabetes mellitus, kehamilan</span></span></span><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> multi</span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">, mola hidatidosa, dan thrombophilias (faktor V Leiden, sindrom antifosfolipid, dan kekurangan antithrombin III). Juga, terjadi peningkatan sensitivitas terhadap efek vasopressor dari angiotensin II, kemungkinan dihasilkan dari konsentrasi plasma meningkat </span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">angiotensin I / reseptor B2 bradikinin heterodimers.</span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span lang="IN"></span></span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Faktor genetik tampaknya memainkan peran dalam patogenesis </span></span><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
</span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">preeklamsia. Angiotensinogen T235 varian gen dan faktor V Leiden mutasi telah dianggap berhubungan dengan preeklamsia. <span style="background: white; mso-shading-themecolor: background1;">Kejadian preeklampsia pada kehamilan yang rumit </span><span style="background: white;">oleh trisomi 13 telah terbukti secara signifikan lebih tinggi daripada </span></span></span><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
</span><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">dengan kehamilan</span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> karyotypic </span></span><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">yang </span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">normal.</span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="longtext"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></b></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Patofisiologi Multiorgan dan Patologi </span></b></div><div class="MsoListParagraph" style="color: purple; line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Cardiopulmonary</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Pada wanita dengan preeklamsia, ada peningkatan sistemik resistensi vaskular dan penurunan patologis dalam hipervolemia dari kehamilan normal. Dengan kata lain, pengurangan plasma volume dan hemokonsentrasi adalah keunggulan dari kondisi ini, dan sebanding dengan tingkat keparahan penyakit perubahan hemodinamik. Perempuan dengan preeklamsia berat dan eklampsia mempunyai fungsi hiperdinamik ventrikel kiri, normal tinggi meningkat untuk resistensi pembuluh darah sistemik, normal atau meningkat tekanan baji kapiler paru, dan tekanan rendah vena sentral. Wanita dengan preeklamsia melapis pada hipertensi kronis juga memiliki resistensi pembuluh darah sistemik yang meningkat,<br />
mengisi tekanan sisi kiri, dan meningkatnya stroke volume indeks di ventrikel kiri.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Morbiditas kardiovaskular akut pada preeklamsia termasuk pada kondisi berikut: edema paru, paru-paru cedera akut/ sindrom gangguan pernapasan akut yang membutuhkan tekanan positif mekanik ventilasi, infark miokard, dan kardiopulmoner<br />
penangkapan.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Edema paru adalah cardiopulmonary paling umum yang merupakan komplikasi dari preeklamsia. Seperti diketahui dari persamaan Starling,<br />
penurunan tekanan onkotik, peningkatan tekanan hidrostatik, atau perubahan dalam permeabilitas kapiler akan predisposisi ekstravasasi cairan dari kompartemen intravaskular.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Semua perubahan terjadi pada preeklamsia dan mungkin buruk setelah melahirkan. Faktor-faktor yang mendukung pengembangan edema paru yaitu usia yang lebih tua, multigravida, dan sebelum ada hipertensi kronis. Diagnosis yang cepat dan pengobatan sangat penting sebagai morbiditas yang baik pada ibu dan janin dan kematian yang tinggi jika dibiarkan tidak diobati. Terapi medis dengan furosemid, oksigen, morfin, bersama dengan pembatasan garam dan cairan, harus dilembagakan sebagai dibutuhkan. Pengurangan dengan vasodilator afterload mungkin diperlukan.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Infark</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">miokard</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">terjadi pada 1</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">% kehamilan. </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Hannaford</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">et</span><span class="longtext"> </span><span class="hps">al menemukan bahwa</span><span class="longtext"> </span><span class="hps">di</span><span class="longtext"> </span><span class="hps">Royal College of</span><span class="longtext"> </span><span class="hps">General</span><span class="longtext"> </span><span class="hps">Practitionersa, wanita dengan</span><span class="longtext"> </span><span class="hps">riwayat</span><span class="longtext"> </span><span class="hps">preeklamsia</span><span class="longtext"> </span><span class="hps">memiliki</span><span class="longtext"> </span><span class="hps">signifikan</span> <span class="hps">risiko tinggi</span><span class="longtext"> </span><span class="hps">infark miokard</span><span class="longtext"> </span><span class="hps">akut.</span><span class="longtext"> </span><span class="hps">Kejang</span><span class="longtext"> </span><span class="hps">koroner</span><span class="longtext"> </span><span class="hps">mungkin memainkan</span> <span class="hps">peran dalam</span><span class="longtext"> </span><span class="hps">ketiadaan</span><span class="longtext"> </span><span class="hps">faktor risiko</span><span class="longtext"> </span><span class="hps">untuk penyakit</span><span class="longtext"> </span><span class="hps">jantung iskemik</span><span class="longtext">. </span><span class="hps"></span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Kardiomiopati</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">peripartum</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">adalah komplikasi</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">yang jarang terjadi</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="hps">pada preeklamsia</span><span class="longtext">, </span><span class="hps">meskipun</span><span class="longtext"> </span><span class="hps">sejarah</span><span class="longtext"> </span><span class="hps">preeklamsia</span><span class="longtext"> </span><span class="hps">telah dilaporkan</span> <span class="hps">sampai dengan</span><span class="longtext"> </span><span class="hps">70</span><span class="longtext">% perempuan </span><span class="hps">yang mengalami</span><span class="longtext"> </span><span class="hps">kardiomiopati</span><span class="longtext"> </span><span class="hps">peripartum</span><span class="longtext">. </span></span></div><div class="MsoListParagraph" style="color: purple; line-height: 150%; text-align: justify; text-indent: -0.25in;"><span class="longtext"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-font-weight: bold; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Ginjal</span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Kecepatan <span style="background: white;">filtrasi glomerular ginjal dan aliran plasma ginjal secara seragam menurun pada preeklamsia. </span></span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Nitrogen urea darah dan serum kreatinin <span style="background: white;">biasanya tetap dalam rentang normal </span></span></span><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">ketika </span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">tidak hamil. Pengukuran</span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> Serentak <span style="background: white;">laju filtrasi glomerulus dan aliran darah ginjal menunjukkan bahwa fraksi filtrasi lebih rendah selama preeklamsia dibandingkan </span>pada wanita normal selama trimester terakhir</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> kehamilan</span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">.</span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Sedimen urin</span></span><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">e</span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> biasanya </span></span><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">lembut</span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">, namun sedikit leukosit, eritrosit, </span></span><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-spacerun: yes;"> </span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">atau gips selular dapat dilihat. Bila proteinuria berat, gips hialin dapat ditemukan. <span style="background: white; mso-shading-themecolor: background1;">Glomerular kerusakan yang mengakibatkan signifikan </span><span style="background: white;">proteinuria merupakan fitur penting dari preeklamsia. </span></span></span><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Proteinuria <span style="background: white;">pada preeklamsia adalah nonselektif. Tinggi berat molekul protein seperti albumin, bersama dengan protein tubular, hilang dalam urine.</span></span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Ada penurunan asam urat selama preeklamsia. Tingkat elevasi serum asam urat berkorelasi dengan keparahan proteinuria, perubahan patologis ginjal, dan </span></span><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">kematian </span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">janin</span></span><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">. Preeklamsi dalam kehamilan yang ditandai dengan pengurangan dalam pecahan ekskresi kalsium dan hypocalciuria diucapkan bersama dengan kadar plasma mengurangi dihydroxyvitamin D dan meningkat </span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">tingkat hormon paratiroid.<span style="background: white;"></span></span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Dalam hal</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">patologi</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">, </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">preeklamsia</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">dikaitkan dengan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">glomerulus</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">endotheliosis</span><span class="longtext"> </span><span class="hps">di ginjal</span><span class="longtext">. </span><span class="hps">Pada</span><span class="longtext"> </span><span class="hps">mikroskop</span><span class="longtext"> </span><span class="hps">cahaya,</span> <span class="hps">lumen</span><span class="longtext"> </span><span class="hps">kapiler</span><span class="longtext"> </span><span class="hps">glomerulus</span><span class="longtext"> </span><span class="hps">yang menyempit</span><span class="longtext"> </span><span class="hps">tampak</span><span class="longtext"> </span><span class="hps">berdarah</span><span class="longtext">, </span><span class="hps">danglomeruli</span><span class="longtext"> </span><span class="hps">yang</span><span class="longtext"> </span><span class="hps">diperbesar</span><span class="longtext">. </span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Endotheliosis</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">preeklamsia</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">adalah</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">biasanya tidak</span><span class="longtext"> </span><span class="hps">disertai dengan</span><span class="longtext"> </span><span class="hps">trombi</span><span class="longtext"> </span><span class="hps">kapiler</span><span class="longtext"> </span><span class="hps">terkemuka.</span><span class="longtext"> </span><span class="hps">Pada</span><span class="longtext"> </span><span class="hps">imunofluoresensi</span><span class="longtext">,</span> <span class="hps">tidak ada</span><span class="longtext"> </span><span class="hps">deposit</span><span class="longtext"> </span><span class="hps">imun dalam</span><span class="longtext"> </span><span class="hps">glomerulus</span><br />
<span class="hps">dan tingkat</span><span class="longtext"> </span><span class="hps">komplemen</span><span class="longtext"> </span><span class="hps">serum</span><span class="longtext"> </span><span class="hps">yang normal</span><span class="longtext">. </span><span class="hps">Deposisi</span><span class="longtext"> </span><span class="hps">fibrinogen</span> <span class="hps">derivatif</span><span class="longtext"> </span><span class="hps">kadang-kadang dapat</span><span class="longtext"> </span><span class="hps">terlihat.</span><span class="longtext"> </span><span class="hps">mikroskop elektron</span> <span class="hps">menunjukkan</span><span class="longtext"> </span><span class="hps">pelestarian</span><span class="longtext"> </span><span class="hps">relatif dari</span><span class="longtext"> </span><span class="hps">proses</span><span class="longtext"> </span><span class="hps">kaki</span><span class="longtext"> </span><span class="hps">podocytes</span><span class="longtext">,</span> <span class="hps">tapi ada</span><span class="longtext"> </span><span class="hps">kehilangan</span><span class="longtext"> </span><span class="hps">fenestrae</span><span class="longtext"> </span><span class="hps">endotel</span><span class="longtext">, </span><span class="hps">dan sel</span><span class="longtext"> </span><span class="hps">endotel</span><br />
<span class="hps">menjadi bengkak dan</span><span class="longtext"> </span><span class="hps">terpisah dari</span><span class="longtext"> </span><span class="hps">membran basal</span><span class="longtext"> </span><span class="hps">oleh</span> <span class="hps">elektron-</span><span class="longtext">Lucent </span><span class="hps">material. Focal</span><span class="longtext"> </span><span class="hps">segmental</span><span class="longtext"> </span><span class="hps">glomerulosclerosis</span><span class="longtext"> </span><span class="hps">menyertai</span> <span class="hps">glomerulus</span><span class="longtext"> </span><span class="hps">yang</span><span class="longtext"> </span><span class="hps">endotheliosis</span><span class="longtext"> </span><span class="hps">umum</span><span class="longtext"> </span><span class="hps">preeklampsia</span> <span class="hps">pada hingga 50</span><span class="longtext">% dari </span><span class="hps">cases. </span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Kekhususan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">endotheliosis</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">untuk mendiagnosis</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">preeklamsia</span><span class="longtext"> </span><span class="hps">telah</span><span class="longtext"> </span><span class="hps">dipertanyakan oleh</span><span class="longtext"> </span><span class="hps">sebuah studi penting</span> <span class="hps">yang menunjukkan</span><span class="longtext"> </span><span class="hps">bahwa bahkan</span><span class="longtext"> </span><span class="hps">wanita dengan</span><span class="longtext"> </span><span class="hps">kehamilan</span><span class="longtext"> </span><span class="hps">nonproteinuric</span> <span class="hps">hipertensi</span><span class="longtext"> </span><span class="hps">serta</span><span class="longtext"> </span><span class="hps">wanita hamil normal</span><span class="longtext"> </span><span class="hps">dipamerkan</span><span class="longtext"> </span><span class="hps">endotheliosis</span><span class="longtext">,</span> <span class="hps">meskipun</span><span class="longtext"> </span><span class="hps">forms ringan</span><span class="longtext"> </span><span class="hps">ini menunjukkan</span><span class="longtext"> </span><span class="hps">endotheliosis</span><span class="longtext"> </span><span class="hps">yang merupakan</span> <span class="hps">spektrum</span><span class="longtext"> </span><span class="hps">terlihat pada</span><span class="longtext"> </span><span class="hps">kehamilan</span><span class="longtext">, </span><span class="hps">dengan</span><span class="longtext"> </span><span class="hps">bentuk parah</span><span class="longtext"> </span><span class="hps">yang sesuai dengan</span> <span class="hps">preeklamsia</span><span class="longtext">. </span><span class="hps">Perubahan</span><span class="longtext"> </span><span class="hps">glomerulus</span><span class="longtext"> </span><span class="hps">biasanya hilang dalam</span><span class="longtext"> </span><span class="hps">8</span> <span class="hps">minggu setelah persalinan</span><span class="longtext">, </span><span class="hps">yang merupakan waktu</span><span class="longtext"> </span><span class="hps">yang sama ketika</span><span class="longtext"> </span><span class="hps">hipertensi</span> <span class="hps">dan proteinuria</span><span class="longtext"> </span><span class="hps">menyelesaikan.<span style="background: white;"></span></span></span></div><div class="MsoListParagraph" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-font-weight: bold; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Central Nervous System </span><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-font-weight: bold; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Komplikasi sistem saraf pusat pada preeklamsia adalah paling sering akibat perdarahan otak, edema otak, trombotik microangiopathy, dan vasokonstriksi serebral. Hal ini mengakibatkan mendadak kejang (eklampsia), bersama dengan sakit kepala, penglihatan kabur, scotoma, dan kebutaan kortikal. Kebanyakan patologis deskripsi yang diperoleh dengan Sheehan dan Lynch dari mereka nekropsi studi, yang mengungkapkan pendarahan otak kotor dan berbagai tingkat petechiae, bersama dengan trombus dalam microvessels. Etiologi tepat dari kejang tidak jelas, meskipun faktor-faktor angiogenik seperti sFlt-1 dan seng</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Patogenesis mungkin memainkan peran. Kejang grand mal biasanya, <br />
dan berhubungan dengan prognosis yang lebih buruk jika mereka terjadi lebih awal daripada 32 minggu kehamilan. Sayangnya, sulit untuk memprediksi risiko <span style="background: white;"><br />
</span>kejang karena ada tampaknya tidak ada korelasi antara besaran kenaikan tekanan darah atau derajat proteinuria. Anehnya, kejadian eklampsia setelah melahirkan terlambat meningkat meskipun penurunan keseluruhan kejadian eklampsia. <span style="background: #EBEFF9;"><br style="mso-special-character: line-break;" /> <br style="mso-special-character: line-break;" /> </span></span><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Pengakuan Awal Preeklampsia</span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Penelitian ini sedang berlangsung untuk mengidentifikasi tes skrining unik yang akan memprediksi risiko preeklamsia berkembang sebelum gejala muncul. Banyak penelitian telah dilakukan untuk memverifikasi signifikan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">perubahan dalam faktor-faktor angiogenik seperti PlGF, sFlt-1, atau seng sebelum</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">imbulnya preeclampsia. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Perubahan dalam serum PlGF dilihat pada trimester pertama, sedangkan perbedaan dalam sFlt-1 dan seng yang terlihat di trimester kedua. PlGF urin juga secara signifikan menurun pada trimester kedua dibandingkan dengan normotensif controls. Selain itu, arteri yang abnormal rahim Doppler velocimetry<br />
pada trimester pertama dan kedua telah diusulkan sebagai barang skrining tes untuk memprediksi preeclampsia. Menggabungkan 3 biomarker menjadi angiogenik, tunggal index atau dengan arteri rahim Doppler 128-130 mungkin lebih prediktif daripada penanda tunggal saja. Apakah biomarker angiogenik sensitif dan spesifik<br />
cukup untuk penggunaan klinis luas masih harus dipelajari. Ini kemungkinan pertanyaan akan dijawab oleh World Health ambisius Organisasi prospektif kohort studi terhadap lebih dari 12.000 perempuan, yang melibatkan negara-negara berkembang di 4 benua dalam penggunaan angiogenik biomarker untuk penyaringan preeklamsia.</span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><span class="longtext"><b><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Podocyte Dan Preeclampsia </span></b></span><b><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Meskipun laporan sebelumnya bahwa podocyte tersebut diawetkan dalam </span></span><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="longtext">preeklamsia, ada peningkatan bukti bahwa hal itu dipengaruhi. </span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Podocyte adalah sel epitel khusus yang melapisi viseral glomerular basement membran dalam glomerulus. Ini membantu untuk <span style="background: white;">membatasi kehilangan protein dengan kompleks celah diafragma-nya. </span>Bersama-sama dengan <span style="background: white;">basement membran glomerulus dan endotelium fenestrated, </span>mereka membentuk penghalang filtrasi glomerulus. Sebuah hewan tengara <span style="background: white;">studi oleh Eremina dkk menunjukkan bahwa ketika salah satu alel dari VEGF adalah </span>dihapus khususnya di podocyte, ginjal mengembangkan patologis yang khas fitur preeclampsia.</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Selanjutnya, sebuah studi kecil <span style="background: white;">otopsi menunjukkan materi downregulation yang podocyte-spesifik protein nephrin dan synaptopodin pada wanita dengan berat </span></span></span><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="longtext">preeclampsia.134 klinis, podocytes kemih (podocyturia) adalah ditemukan dalam jumlah yang meningkat pada pasien dengan preeklamsia, menandakan </span><br />
<span class="longtext">kelompok process menumpahkan kami juga mempelajari ekspresi podocyte-spesifik protein synaptopodin dan podocin oleh immunofluoresence </span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">pada biopsi ginjal dari 20 pasien dengan preeklamsia dalam waktu 4 minggu setelah persalinan. Berbeda dengan studi otopsi, kami <span style="background: white;">menemukan bahwa pada pasien dengan endotheliosis parah, synaptopodin ekspresi baik tidak berubah atau hanya sedikit menurun, sedangkan </span>ekspresi podocin adalah menurunkan regulasi seragam (tidak diterbitkan </span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="longtext">data). </span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Sebaliknya, pasien dengan endotheliosis ringan telah diawetkan </span></span><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
</span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">synaptopodin dan ekspresi podocin. <span style="background: white;">Kami menyimpulkan bahwa podocytespecific </span></span></span><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
</span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">protein hanya terpengaruh pada preeklamsia berat. Selain itu, </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="longtext">kita mempelajari penggunaan podocyturia sebagai penanda diagnostik untuk </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-spacerun: yes;"> </span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">preeklampsia pada 56 wanita dengan kehamilan berisiko tinggi, termasuk 28 </span></span><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
</span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">dengan preeklamsia dan kondisi lain seperti hipertensi (gestasional <span style="background: white; mso-shading-themecolor: background1;">atau kronis), diabetes (gestational atau kronis), dan menemukan bahwa </span><span style="background: white;">sensitivitas dan spesifisitas adalah 39% podocyturia dan 79%, </span>masing-masing (unpublished data). Jadi, kita menyimpulkan bahwa podocyturia <span style="background: white;">mungkin, berguna meskipun bukan alat klinis yang spesifik dalam mengevaluasi </span>preeklamsia. <span style="background: white;">Namun, kami merasa bahwa penelitian ini perlu </span>divalidasi dalam kohort yang lebih besar.</span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Pencegahan preeklamsi <span style="background: white;"></span></span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Selama beberapa dekade terakhir, baik besar dan kecil, klinis <span style="background: white;"><span style="mso-spacerun: yes;"> </span></span>percobaan telah berusaha untuk mengungkap sebuah obat yang dapat mencegah preeklamsia. Namun pencegahan primer yang efektif terbukti sangat sulit ketika patogenesis tidak jelas. <br style="mso-special-character: line-break;" /> <br style="mso-special-character: line-break;" /> </span></div><div class="MsoListParagraph" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Diuretik </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Penyidik percaya sejak awal bahwa retensi natrium adalah penyebab edema dan hipertensi pada preeklamsia, dan karena itu upaya dilakukan untuk profilaksis mengelola diuretics. Sekarang diketahui bahwa volume plasma lebih rendah pada preeklamsia daripada di keadaan normal dan ada kecenderungan hemokonsentrasi. <span style="background: #EBEFF9;"><br />
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Dengan demikian, diuretik dapat memperburuk hipovolemia, yang pada gilirannya akan merangsang sistem renin-angiotensin dan memperparah hipertensi. Jadi, diuretik tidak lagi direkomendasikan.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoListParagraph" style="color: purple; line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Suplementasi Kalsium </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Laporan awal dari hypocalciuria, peningkatan kepekaan terhadap angiotensin II, dan menurunnya tingkat dihydroxyvitamin D pada wanita dengan preeklamsia </span></span></div><div class="MsoListParagraph" style="color: purple; line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Aspirin </span></span><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Karena preeklampsia dikaitkan dengan vasospasme dan aktivasi dari sistem koagulasi-hemostasis, aspirin dosis rendah dianggap bermanfaat karena menghambat biosintesis tromboksan platelet A2 dengan sedikit efek pada produksi prostasiklin vaskuler, </span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">sehingga mengurangi dan kelainan koagulasi vasospasme. </span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Dalam </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="longtext"><span style="background: white;">1980-an dan 1990-an, beberapa percobaan dengan aspirin menunjukkan penurunan yang signifikan dalam kejadian hipertensi kehamilan dan preeklamsia. </span></span></span><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoListParagraph" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Suplementasi vitamin C dan E </span><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Salah satu penyebab disfungsi sel endotel ibu mungkin perfusi plasenta yang buruk memulai pelepasan faktor untuk menginduksi stres oksidatif. Penggunaan vitamin C dan E untuk mencegah preeklampsia pada wanita berisiko tinggi dan menemukan bahwa preeklamsia secara signifikan rendah</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">. Selain itu, dalam sebuah penelitian menunjukkan tingkat peningkatan pada bayi lahir rendah. Pada saat ini, kami tidak merekomendasikan menggunakan vitamin C dan E pada pencegahan preeklamsia.<span style="background: white;"></span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><span class="longtext"><b><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Manajemen</span></b></span><span class="longtext"><b><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> Preeklamsia </span></b></span><b><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></b></div><div class="MsoListParagraph" style="color: purple; line-height: 150%; text-align: justify; text-indent: -0.25in;"><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Rujukan</span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Pengobatan yang paling dapat diandalkan preeklamsia adalah </span></span><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">rujukan</span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">.</span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Penghapusan plasenta biasanya menghasilkan perbaikan yang cepat, meskipun </span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">dalam beberapa kasus, gejala dapat bertahan selama beberapa hari setelah melahirkan. Keputusan untuk memberikan melibatkan menyeimbangkan risiko memburuknya <span style="background: white;">preeklamsia terhadap orang prematuritas. </span>Rujukan dijamin untuk wanita yang mengalami preeklamsia berat setelah 34 minggu kehamilan. </span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Dalam setiap wanita antara 32 sampai 34 minggu usia kehamilan dengan </span></span><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
</span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">preeklamsia <span style="background: white;">berat</span>, rujukan yang cepat harus dipertimbangkan, terutama jika </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="longtext">manajemen konservatif telah gagal. <span style="background: white;">Wanita di bawah 28 minggu kehamilan yang mengembangkan preeklamsia berat dapat dikelola secara konservatif jika ibu dan janin dipantau secara ketat dalam tersier <span style="mso-spacerun: yes;"> </span>pusat </span>perinatal.</span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Wanita yang memiliki preeklamsia ringan juga harus tetap </span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">dimonitor untuk tanda-tanda kerusakan yang cepat. Jika tanda-tanda, seperti sakit kepala, <span style="background: white;">nyeri epigastrium, perubahan visual, atau hasil laboratorium abnormal, maka pasien harus dirawat di rumah sakit. </span>Ketika <span style="background: white;">elevasi tekanan darah ringan, dengan hasil laboratorium normal dan evaluasi janin yang menguntungkan, manajemen konservatif. </span>Pasien dapat diobati secara rawat jalan atau rawat inap, tergantung kepatuhan pasien. Pasien yang menjaga di tempat tidur <span style="background: white; mso-shading-themecolor: background1;">istirahat dan dapat kembali untuk pengujian nonstress janin dan penilaian pertumbuhan</span> dapat dikelola sebagai pasien rawat jalan. Jika tidak, mereka harus mengaku rumah sakit. <span style="background: white;">Tujuan pengobatan adalah untuk mencegah kejang, tekanan darah rendah untuk menghindari akhir kerusakan organ ibu,</span></span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">sementara bertujuan untuk sebagai kematangan janin sebanyak mungkin, dan untuk mempercepat rujukan saat ini.</span></span><span class="longtext"><b><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></b></span></div><div class="MsoListParagraph" style="color: purple; line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-font-weight: bold; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-font-weight: bold; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Obat</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-font-weight: bold; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-font-weight: bold; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">antihipertensi</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-font-weight: bold; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Seperti disebutkan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">sebelumnya,</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">tingkat</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">kontrol tekanan darah</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">optimal</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="hps">dalam</span><span class="longtext"> </span><span class="hps">kehamilan dengan komplikasi</span><span class="longtext"> </span><span class="hps">hipertensi</span><span class="longtext"> </span><span class="hps">tidak diketahui</span><span class="longtext">.</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Kurang dari</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">kontrol </span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">yang </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">ketat</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">dapat menurunkan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">resiko</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">kecil</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">untuk bayi</span><span class="longtext"> </span><span class="hps">usia kehamilan</span><span class="longtext">, </span><span class="hps">tetapi dapat</span><span class="longtext"> </span><span class="hps">meningkatkan risiko</span><span class="longtext"> </span><span class="hps">pernapasan</span> <span class="hps">distres</span><span class="longtext"> </span><span class="hps">sindrom</span><span class="longtext"> </span><span class="hps">hipertensi,</span><span class="longtext"> </span><span class="hps">bayi yang baru lahir</span><span class="longtext"> </span><span class="hps">parah di</span> <span class="hps">ibu, dan</span><span class="longtext"> </span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">hospitalisasi </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">antenatal.</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Tujuan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">utama dari pengobatan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">hipertensi pada</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">pasien</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">jarak jauh</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="hps">dari istilah</span><span class="longtext"> </span><span class="hps">ini</span><span class="longtext"> </span><span class="hps">untuk memperpanjang</span><span class="longtext"> </span><span class="hps">kehamilan</span><span class="longtext">. </span><span class="hps">Tidak ada</span><span class="longtext"> </span><span class="hps">yang menarik</span> <span class="hps">studi yang</span><span class="longtext"> </span><span class="hps">menunjukkan</span><span class="longtext"> </span><span class="hps">hasil klinis</span><span class="longtext"> </span><span class="hps">diperbaiki dengan</span> <span class="hps">pengobatan</span><span class="longtext"> </span><span class="hps">preeklampsia</span><span class="longtext"> </span><span class="hps">ringan</span><span class="longtext"> </span><span class="hps">dan obat-obatan</span><span class="longtext"> </span><span class="hps">antihipertensi</span><span class="longtext">. </span><span class="hps">Bahkan</span><span class="longtext">,</span> <span class="hps">studi yang</span><span class="longtext"> </span><span class="hps">telah menggunakan</span><span class="longtext"> </span><span class="hps">labetalol</span><span class="longtext"> </span><span class="hps">untuk mengobati</span><span class="longtext"> </span><span class="hps">wanita dengan</span><span class="longtext"> </span><span class="hps">kehamilan</span><span class="longtext"> </span><span class="hps">yang ringan</span> <span class="hps">hipertensi atau</span><span class="longtext"> </span><span class="hps">preeklamsia</span><span class="longtext"> </span><span class="hps">telah menunjukkan tidak ada</span><span class="longtext"> </span><span class="hps">perbaikan dalam</span><span class="longtext"> </span><span class="hps">perinatal</span> <span class="hps">hasil</span><span class="longtext">, </span><span class="hps">dengan peningkatan </span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">kejadian </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">bayi yang</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">kecil untuk</span><span class="longtext"> </span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">usia</span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">kehamilan</span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">. </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Meskipun demikian</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">, </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">resiko</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">: </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">rasio manfaat</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">untuk</span><span class="longtext"> </span><span class="hps">terapi obat</span><span class="longtext"> </span><span class="hps">pada wanita dengan</span><span class="longtext"> </span><span class="hps">preeklamsia</span><span class="longtext"> </span><span class="hps">ringan</span><span class="longtext"> </span><span class="hps">tidak jelas</span><span class="longtext">.</span><br />
<span class="hps">Saat ini</span><span class="longtext">, tidak ada </span><span class="hps">rekomendasi</span><span class="longtext"> </span><span class="hps">yang seragam</span><span class="longtext"> </span><span class="hps">untuk mengelola</span><span class="longtext"> </span><span class="hps">antihipertensi</span><br />
<span class="hps">obat untuk</span><span class="longtext"> </span><span class="hps">pasien dengan</span><span class="longtext"> </span><span class="hps">preeklamsia</span><span class="longtext"> </span><span class="hps">ringan.</span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Tujuan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">pengobatan untuk perempuan dengan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">hipertensi berat</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">adalah untuk</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="hps">menurunkan</span><span class="longtext"> </span><span class="hps">tekanan darah</span><span class="longtext"> </span><span class="hps">untuk mencegah</span><span class="longtext"> </span><span class="hps">pendarahan otak</span><span class="longtext">. </span><span class="hps">Meskipun</span><br />
<span class="hps">rekomendasi</span><span class="longtext"> </span><span class="hps">tradisional didasarkan pada</span><span class="longtext"> </span><span class="hps">tekanan darah</span><span class="longtext"> </span><span class="hps">diastolik</span><span class="longtext">, sebuah</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Tinjauan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">retrospektif</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">dari 28</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">wanita dengan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">preeklamsia</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">berat yang</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">mengalami kecelakaan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">serebrovaskular</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">menunjukkan bahwa</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">90% memiliki</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">sistolik</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">tekanan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">darah</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">160</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">mm Hg</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">,</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">tetapi hanya</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">12,5</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">% </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">memiliki darah</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">diastolik</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">tekanan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">110</span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">mmHg.</span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Rekomendasi</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">adalah bahwa</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">antihipertensi</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">terapi harus</span><span class="longtext"> </span><span class="hps">diberikan untuk</span><span class="longtext"> </span><span class="hps">tekanan darah</span><span class="longtext"> </span><span class="hps">sistolik</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">160</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">mmHg atau</span><span class="longtext"> </span><span class="hps">diastolik</span><span class="longtext"> </span><span class="hps">110</span><span class="longtext"> </span><span class="hps">mmHg</span><span class="longtext">, </span><span class="hps">untuk mencapai</span><span class="longtext"> </span><span class="hps">pengukuran</span><span class="longtext"> </span><span class="hps">sistolik</span> <span class="hps">dari</span><span class="longtext"> </span><span class="hps">140-155</span><span class="longtext"> </span><span class="hps">mmHg</span><span class="longtext"> </span><span class="hps">dan /</span><span class="longtext"> </span><span class="hps">atau</span><span class="longtext"> </span><span class="hps">pengukuran</span><span class="longtext"> </span><span class="hps">diastolik</span><span class="longtext"> </span><span class="hps">90 sampai</span> <span class="hps">105</span><span class="longtext"> </span><span class="hps">mmHg</span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">.</span></span></div><div class="MsoListParagraph" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-font-weight: bold; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-font-weight: bold; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Magnesium Sulfat </span><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-font-weight: bold; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Magnesium sulfat digunakan untuk mencegah kejang pada wanita dengan preeclampsia</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">. Itu </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">telah dibuktikan dalam acak uji klinis neurologi terkemuka saat merasa bahwa tradisional antiepileptics (fenitoin, diazepam) lebih baik akan mengontrol kejang. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Percobaan ini membuktikan bahwa magnesium sulfat parenteral lebih unggul baik fenitoin dan diazepam dalam mencegah awal dan berulang <span style="background: white;"><br />
</span>kejang, dan dalam menurunkan mortality ibu. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Namun, penggunaan magnesium sulfat masih kontroversial pada wanita dengan preeklamsia ringan karena kejadian kejang pada populasi ini sangat rendah. Sebuah percobaan prospektif besar yang melibatkan lebih dari 10.000 pasien menunjukkan bahwa penggunaan profilaksis magnesium sulfat menurunkan risiko keseluruhan eclampsia. Namun, karena jumlah besar diperlukan untuk mengobati, beberapa peneliti merasa bahwa seharusnya diberikan hanya bila kondisi ini Namun "berat.", kita dan lainnya merasa bahwa karena keparahan preeklampsia mungkin terduga, manfaat pengobatan lebih besar daripada risiko.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"> </span><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Magnesium sulfat memiliki manfaat tambahan mengurangi kejadian </span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">plasenta abruption.</span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span class="longtext"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Preeklamsia Dan Hasil Jangka Panjang Jantung / Stroke </span></b></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></b></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Sejumlah studi epidemiologi telah menunjukkan bahwa setelah </span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="longtext"><span style="background: white;">kehamilan dengan preeklamsia, seorang wanita memiliki risiko yang lebih tinggi </span>konsekuensi kardiovaskular. </span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Masa depan ini <span style="background: white;">mungkin karena berupa proses patofisiologis umum atau subklinis </span>kerusakan vaskular. <span style="background: white; mso-shading-themecolor: background1;">Risiko</span><span style="background: white;"> penyakit jantung yang fatal serta iskemik yang fatal merupakan peristiwa pada wanita dengan preeklamsia yaitu dua kali lebih yang lebih disukai. Selanjutnya, </span>risiko tinggi kejadian kardiak di masa depan baik primipara pada <span style="background: white;">wanita dengan preeklamsia serta mereka dengan preeklamsia dalam setiap </span>kehamilan. </span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Waktu preeklamsia adalah penting karena preeklamsia sebelum 37 minggu dikaitkan dengan <span style="background: white;">peningkatan 8 kali lipat dari penyakit jantung iskemik untuk perempuan dibandingkan dengan orang-orang dengan kehamilan normotensif setelah period ini. Risiko terkena penyakit jantung iskemik juga dipengaruhi oleh </span></span></span><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="longtext">penyakit parah pasien dengan tekanan darah 160/110 mmHg dan keberadaan proteinuria memiliki RR 3,65 dari iskemik penyakit jantung di kemudian hari dibandingkan dengan mereka dengan preeklamsia ringan.</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Serangan </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">preeklamsia</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">berat</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">pada</span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> awal</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">(sebelum</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">24 minggu</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">)</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">tampaknya</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">berperilaku sangat</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">berbeda dari</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">serangan akhir</span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">(</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">setelah 24 </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">minggu</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">)</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="hps">preeklamsia</span><span class="longtext">. </span><span class="hps">Yang pertama</span><span class="longtext"> </span><span class="hps">memiliki</span><span class="longtext"> </span><span class="hps">morbiditas</span><span class="longtext"> </span><span class="hps">maternal</span><span class="longtext"> </span><span class="hps">dan perinatal</span><span class="longtext"> </span><span class="hps">tinggi</span><br />
<span class="hps">dan kesempatan</span><span class="longtext"> </span><span class="hps">50</span><span class="longtext">% dari </span><span class="hps">kekambuhan</span><span class="longtext"> </span><span class="hps">preeklampsia pada</span><span class="longtext"> </span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">kehamilan </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">berikutnya.</span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Mereka</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">juga menunjukkan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">hipertensi</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">lebih kronis</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">dan peningkatan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">mikroalbuminuria</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">, </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">tetapi tidak ada perbedaan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">dalam </span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">kejadian</span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">tersebut</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">dari</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">ketidakpekaan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">insulin atau</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">fitur lain</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">dari sindrom</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">metabolik</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">.</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Seperti</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">diketahui</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">mikroalbuminuria</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">menjadi prediktor</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">kuat</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">iskemik</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><br />
<span class="hps">penyakit jantung</span><span class="longtext"> </span><span class="hps">hipertensi</span><span class="longtext"> </span><span class="hps">pada individu</span><span class="longtext"> </span><span class="hps">dalam populasi umum</span><span class="longtext">,</span> <span class="hps">kelompok ini</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">berada pada</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">risiko lebih tinggi</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">terkena</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">kardiovaskular.</span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Data ini menunjukkan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">suatu</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">patogenesis</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">yang berbeda untuk</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">awal</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">preeklamsia</span><span class="longtext"> </span><span class="hps">dibandingkan</span><span class="longtext"> </span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">serangan</span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span lang="IN">terlambat</span></span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">, </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">dengan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">vaskular</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">hipertensi</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">terkait</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">etiologi</span><span class="longtext"> </span><span class="hps">pada mereka dengan penyakit</span><span class="longtext"> </span><span class="hps">onset dini</span><span class="longtext">.</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Tampaknya ada</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">risiko fatal yang lebih tinggi</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">dibandingkan dengan</span><span class="longtext"> </span><span class="hps">fatal stroke</span><span class="longtext"> </span><span class="hps">setelah</span><span class="longtext"> </span><span class="hps">preeklamsia</span><span class="longtext">, </span><span class="hps">dengan</span> <span class="hps">keseluruhan</span><span class="longtext"> </span><span class="hps">meningkat</span><span class="longtext"> </span><span class="hps">pada wanita dengan</span><span class="longtext"> </span><span class="hps">preeklamsia</span><span class="longtext"> </span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">serangan</span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> awal</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">(37</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">minggu</span><span class="atn">) (</span><span class="longtext">RR </span><span class="hps">5.</span></span><span class="hps"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">0).</span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Singkatnya</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">, </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">wanita dengan</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">preeklamsia</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">memiliki</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">4</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> </span></span><span class="hps"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">kali lipat peningkatan</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span class="hps">risiko</span><span class="longtext"> </span><span class="hps">hipertensi dan</span><span class="longtext"> </span><span class="hps">risiko</span><span class="longtext"> </span><span class="hps">2</span><span class="longtext"> </span><span class="hps">kali lipat</span><span class="longtext"> </span><span class="hps">peningkatan</span><span class="longtext"> </span><span class="hps">iskemik</span> <span class="hps">penyakit jantung</span><span class="longtext"> </span><span class="hps">dan stroke</span><span class="longtext">. </span><span class="hps">Mekanisme</span><span class="longtext"> </span><span class="hps">yang tepat</span><span class="longtext"> </span><span class="hps">perlu dipahami</span><span class="longtext">.</span> <span class="hps">Namun,</span><span class="longtext"> </span><span class="hps">tampaknya ada</span><span class="longtext"> </span><span class="hps">cukup</span><span class="longtext"> </span><span class="hps">mengumpulkan</span><span class="longtext"> </span><span class="hps">bukti untuk</span> <span class="hps">menunjukkan bahwa</span><span class="longtext"> </span><span class="hps">riwayat</span><span class="longtext"> </span><span class="hps">preeklampsia</span><span class="longtext"> </span><span class="hps">harus menjadi bagian</span><span class="longtext"> </span><span class="hps">dari sebuah</span><span class="longtext"> </span><span class="hps">awal</span> <span class="hps">evaluasi untuk</span><span class="longtext"> </span><span class="hps">penyakit jantung</span><span class="longtext"> </span><span class="hps">iskemik</span><span class="longtext"> </span><span class="hps">pada wanita</span><span class="longtext">.</span></span><span class="longtext"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><span class="longtext"><b><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Ginjal </span></b></span><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Ada juga bukti yang muncul bahwa preeklamsia terkait dengan mengembangkan penyakit ginjal di kemudian hari. </span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Meskipun glomerulus <span style="background: white;">cedera selama periode preeklamsia, hal itu diperkirakan sebelumnya preeklampsia yang tidak memiliki efek buruk pada ginjal dalam </span>jangka panjang.</span></span><span class="longtext"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"> <span lang="IN" style="background: white; mso-shading-themecolor: background1;">Sebuah studi sebelumnya yang diikuti pasien yang mengalami sindrom HELLP selama 5 tahun atau</span><span lang="IN" style="background: white;"> lebih terungkap secara signifikan tinggi diastolik dan sistolik tekanan darah tetapi tidak ada perbedaan dalam </span></span></span><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"><span style="mso-spacerun: yes;"> </span><span class="longtext">kreatinin clearance atau urin microalbumin / kreatinin ratio. </span></span><span class="longtext"><span style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;"></span></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span class="longtext"><span lang="IN" style="background: white; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Demikian pula, wanita dengan preeklampsia dan kehamilan-induced hiper</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">ketegangan yang diteliti selama 10 tahun itu ditemukan memiliki peningkatan risiko pengembangan hipertensi kronis, tetapi tidak terpengaruh serum urea dan kreatinin levels.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Namun, yang lebih baru penelitian menunjukkan bahwa ada konsekuensi ginjal. Medical Kelahiran Registry database Norwegia dari semua childbirths di Norwegia sejak 1967 mengungkapkan bahwa wanita dengan preeklamsia yang melahirkan keturunan berat badan lahir rendah memiliki risiko meningkat secara substansial di kemudian hari </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">yang </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">memiliki biopsy ginjal. </span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Selanjutnya, sejarah preeklamsia adalah terkait dengan terjadinya mikroalbuminuria tinggi dan hipertensi, baik yang mungkin prediksi masa depan </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">penyakit </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">ginjal. Menariknya, sejumlah besar wanita dengan preeklamsia yang kemudian dibiopsi dipamerkan focal segmental glomerulosklerosis</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">, </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">ini menunjukkan bahwa glomerulosklerosis focal segmental mungkin nefropati spesifik setelah preeklamsia. Paling mengejutkan, laporan terbaru oleh Vikse dkk preeklamsia menunjukkan bahwa selama kehamilan pertama adalah terkait dengan RR 4,7 pengembangan </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">penyakit </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">ginjal stadium akhir.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Wanita yang mengembangkan preeclampsia selama kedua mereka pada kehamilan ketiga mereka meningkat RR </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">sampai </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">15.5. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;">Para penulis menyimpulkan bahwa preeklamsia penanda peningkatan risiko berikutnya stadium akhir penyakit ginjal. Tentu saja semua yang disebutkan di atas temuan dapat dikacaukan oleh fakta bahwa wanita dengan preeklamsia memiliki ginjal yang tidak terdiagnosis penyakit sebelum kehamilan mereka. Bahkan, sebuah penelitian di Jepang kecil menunjukkan bahwa ketika antepartum klinis dan data postpartum adalah 19 dari 86 wanita, atau 22,1%, dikabarkan mendasari penyakit ginjal. Namun demikian, kami menyimpulkan bahwa ada banyak bukti <span style="background: white;"><br />
</span>bahwa preeklamsia mengarah ke faktor risiko untuk penyakit ginjal kronis <span style="background: white;"><br />
</span>dan mungkin perkembangan stadium akhir penyakit ginjal. Namun, risiko absolut tetap kecil.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-bidi;"></span></div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; text-align: justify;"><br />
</div><span style="color: purple;"> </span><span style="color: purple; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><br clear="all" style="page-break-before: always;" /> </span> <div align="center" class="MsoNormal" style="color: purple; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">DAFTAR PUSTAKA</span></b></div><div align="center" class="MsoNormal" style="color: purple; text-align: center;"><br />
</div><div class="MsoNormal" style="color: purple; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-style: italic;">Jim</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> <span style="mso-bidi-font-style: italic;">Belinda, et al<i>. </i></span><i style="mso-bidi-font-style: normal;">Hypertension in Pregnancy <span style="mso-bidi-font-style: italic;">A Comprehensive Update. </span></i><span style="mso-bidi-font-style: italic;">Cardiology in Review. </span>Volume 18. Number 4. 2010.</span></div></div>blog bidan aie mawarhttp://www.blogger.com/profile/01675794479695431311noreply@blogger.com0tag:blogger.com,1999:blog-8553296400543593835.post-54967454272665271082011-05-12T14:32:00.000+07:002011-05-14T03:37:41.205+07:00ENDOMETRIOSIS<div dir="ltr" style="text-align: left;" trbidi="on"><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>IN</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Endometriosis adalah suatu keadaan dimana endometrium berada di luar tempat yang seharusnya, yaitu di dalam rongga rahim. Endometrium sendiri merupakan lapisan yang melapisi rongga rahim dan dikeluarkan secara siklik saat mens sebagai darah haid.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jaringan ini yang terdiri atas kelenjar-kelenjar dan stroma, terdapat di dalam miometriu m ataupun di luar uterus. Bila jaringan endometrium terdapat di dalam endometrium disebut adenomiosis, dan bila di luar uterus disebut endometriosis. Pembagian ini sekarang sudah tidak dianut lagi, karena baik secara patologik, klinik ataupun etiologi adenomiosis dan endometriosis berbeda. </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada endometriosis jaringan endometrium ditemukan di luar kavum uteri dan di luar myometrium. Menurut urutan yang tersering endometrium di temukan di tempat-tempat sebagai berikut :</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ovarium</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peritoneum dam ligamentum sakrouterium, kavum douglase,dinding belakang uterus,tuba fallopi, pelika vesikouterina,ligamentum rotodum dan sigmoid </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Septum rektovaginal </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kanalis inguinalis </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apendiks</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Umbilikus </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Servik uteri,vagina,kandung kecing,vulva,perineum</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Parut laparotomi </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>9.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar limfe </span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>10.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Walau pun sangat jarang endometriosis dapat di temukan di lengan, paha, pleura dan perikardium</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko tinggi terjadinya endometriosis ditemukan pada: </span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Wanita yang ibu atau saudara perempuannya menderita endometriosis</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Siklus menstuasi 27 hari atau kurang </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menarke</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (menstruasi yang pertama) terjadi lebih awal</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menstruasi berlangsung selama 7 hari atau lebih </span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Orgasme</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> ketika menstruasi</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adapun beberapa gejala terjadinya endometriosis, diantaranya : </span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri di perut bagian bawah dan di daerah panggul </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menstruasi yang tidak teratur (misalnya <i>spotting</i> sebelum menstruasi) </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kemandulan </span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dispareunia</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (nyeri ketika melakukan hubungan seksual). <br />
<br />
<br />
</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Histogenesis</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Teori histogenesis dari endrometiosis yang paling banyak <span> </span>penganutnya adalah teori dari sampso. Menurut teori ini , endrometriosis terjadi karena darah haid mengalir kembali (regurgitasi) melalui tuba ke dalam rongga pelvis. Sudah d buktikan bvahwa darah haid di dapati sel-sel endometrium yang masih hidup. Sel-sel endometrium yang masih hidup ini kemudian, dapat mengadakan implantasi di pelvis.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Teori lain mengenai histogenesis endrometriosis di lontarkan oleh Robert meyer.pada teori ini di kemukankan bahwa endrometriosis terjadi karena<span> </span>rangsangan pada sel-sel epitel bersal dari selom yang dapat mempertahankan hidupnya di daerah pelvis.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rangsangan ini akan menyebabkan metaplasi dari sel-sel epitel itu, sehingga terbentuk jaringan endometrium.teori dari Robert meyer akhir-akhir ini semakin banyak penangtangnya.di samping itu masih terbuka kemunginan timbulnya endometriosis dengan jalan penyebaran melalui jalan darah datau limpe, dan dengan implantasi langsung dari endometrium pada saat oprasi.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Angka kejadian</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Endometriosis selama kurang lebih 30 tahun terakhir ini menunjukan angka kejadian yang meningkat. Angka kejadian antara 5-15 % dapat di temukan di antara semua oprasi pelvik. Endrometriosis jarang di dapatkan orang-orang negro, dan lebih sering di dapat pad wanita-wanita dari golongan sosio-ekonomi yang kuat. </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Yang menarik perhatian ialah bahwa endometriosis lebih sering di temukan pada wanita yang tidak kawin pada umur muda, dan yang tidak mempuyai banyak anak. rupanya funsi ovarium secara seklis yang terus menerus tanpa di selingi oleh kehamilan, memegang peranan dalam terjadinya endometriosis.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Patologi</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gambaran mikroskopi dari endrometriosis sangat variabel. Loksi yang sering terdapat adalah pada ovarium, biasanya disini di dapati pada kedua ovarium. Pada ovarium tampak kista-kista biru kecil sampai kista besar (kadang-kadang sebsar tinju) berisi darah tua menyerupai coklat (kista coklat atau endometrium).</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Darah tua dapat keluar sedikit-sedikit karena luka pada dinding kista, dan dapat menyebabkan perlekatan antara permukaan ovarium dengan uterus, sigmoid dan dinding pelvis. Kista coklat kadang-kadang dapat mengalir dalam jumlah banyak ke dalam rongga peritoneum karena robekan dinding kista, dan menyebabkan acute abdomen. Tuba pada endometriosis biasanya normal. Pada salah satu atau kedua ligamentum sakrouterinum, pada cavum douglasi, dan pada permukaan uterus sebelah belakang yang berwarna kebiru biruan. Juga pada permukaan sigmoid atau rectum seringkali dstroma yang ditemukan benjolan yang berwarna kebirubiruan ini . sebagai akibat dari timbulnya pendarahan pada waktu haid dari jaringan endrometriosis , mudah sekali timbul perlekatan antara alat-alat di sekitar cavum dauglasi.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gambaran mikroskopik</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada pemeriksaan mikroskopik ditemukan cirri-ciri khas bagi endometriosis, yakni kelenjar-kelenjar dan stromaendometrium, dan perdarahan bekas dan baru berupa eritrosit, pigmen hemosiderin, dan sel-sel makrofa berisi hemosiderin. Di sekitarnya tampak sel-sel radang dan jaringan ikat, sebagai reaksi dari jaringan normal di sekelilingnya (jaringan endometriosis). Jaringan endometriosis seperti juga jaringan endometrium didalam uterus, dapat dipengruhi oleh estrogen dan progesterone. Akan tetapi besar pengaruh tidak selalu sama, dan tergantung dari beberapa factor, antara lain dari komposisi endometriosis yang bersangkutan (apakah jaringan kelenjar atau jaringan stroma yang lebih banyak),dari reaksi jaringan disekitarnya, dan sebagainya. Sebagai akibat dari pengaruh hormone-hormon tersebut, sebagaian besar, sarang-sarang endometriosis berdarah secra periodik. Perdarahan yang periodic ini menyebabkan reaksi jaringan sekelilingnya berupa radang dan perlengkapan.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 31.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada kehamilan dapat ditemukan reaksi desidua jaringan endometriosis. Apabila kehamilannya berakhir, reaksi desidua menghilang disertai dengan regresi sarang endometriosis, dan dengan membaiknya keadaan pengaruh baik dari kehamilan kini menjadi dasar pengobatan endometriosis dengan hormon untuk mengadakan apa yang dinamakan kehamilan semu(pseudokpregnenci). Secara mikroskopi endometriosis merupakan sesuatu kehamilan yang jinak, akan tetapi kadang-kadang sifatnya seperti tumor ganas. Antara lain bias terjadi penyebran endometriosis ke paru-pru dan lengan, selain itu bias terdapat infiltrasi ke bawah kavum douglasi<span> </span>ke fasia rektovaginal, ke sigmoid, dan sebagainya.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 31.5pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gambaran klinik</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala-gejala yang sering ditemukan pada penyakit ini ialah:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri perut bawah yang progresif dan dekat paha yang terjadi pada dan selama haid (dismenorea)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dispareunia</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri waktu defekasi, khususnya pada waktu haid</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Poli dan hipermenorea</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infertilitas</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 4.5pt; text-align: justify; text-indent: 31.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dismenorea pada endometriosis biasanya merupakan rasa nyeri waktu haid yang semakin lama semakin hebat.sebab dari dismenorea ini tidak diketahui,tetapi mungkin ada hubungannya dengan vaskularisasi dan perdarahan dalam sarang endometriosis pada waktu sebelum dan semasa haid.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 4.5pt; text-align: justify; text-indent: 31.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri tidak selalu didapatkan pada endometriosis walaupun kelainan sudah luas,sebaiknya kelainan ringan dapat menimbulkan gejala nyeri yang keras.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 4.5pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dispareunia yang merupakan gejala yang dijumpai,disebabkan oleh karena adanya endometriosis di kavum douglasi. Defekasi yang sukar dan sakit terutama pada waktu haid,disebabkan oleh karena adanya endometriosis pada dinding rektosignoid.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 4.5pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kadang-kadang bisa terjadi stenosis dari lumen usus besar tersebut.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 4.5pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Endometriosis kandung kencing jarang terdapat,gejala-gejalanya ialah gangguan miksi,dan hematuria pada waktu haid.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 4.5pt; text-align: justify; text-indent: 31.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ganguan haid dan siklusnya dapat terjadi pada endometriosis apabila kelainan pada ovarium demikian luasnya sehingga fungsi ovarium terganggu.ada korelasi yang nyata antara endometriosis dan infertitas. 30-40% wanita dengan endmetriosis menderita infertilitas.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut Rubin kemungkinan untuk hamil pada wanita dengan endometriosis ialah kurang lebih sebagian dari wanita biasa.faktor penting yang menyebabkan infertilitas pada endometriosis ialah apabila mobilitas tuba terganggu karena fibrosis dan perlekatan jaringan di sekitarnya.pada pemeriksaan ginekologi,khususnya pada pemeriksaan rekto-vagina-abdominal,ditemukan pada endometriosis,ringan benda-benda padat sebesar butir beras sampai butir jagung di kavum douglasi dan pada ligamentum sakroterinum dengan uterus dalam retrofleksi dan terfikasi.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ovarium mula-mula dapat diraba sebagai tumor kecil,akan tetapi bias membesar sampai sebesar tinju.tumor ovarium seringkali terdapat di lateral dan sukar digerakan.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 4.5pt; text-align: justify; text-indent: 31.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biasanya dibuat atas dasar anamesis dan pemerikasaan fisik,dipastikan dengan pemeriksaan laparoskopi. Kuldoskopi kurang bermanfaat terutama jika kavum douglasi ikut serta dalam endometriosis. Pada endometriosis yang ditemukan pada lokasi seperti ferniks vaginea posterior,perineum,paru laparotomi,dan sebagainya,biopsy dapat member kepastian mengenai diagnosis.pemeriksaan laboratorium pada endometriosis tidak member tanda yang khas,apabila ada darah dalam tinja atau air kencing pada waktu haid dapat menjadi petunjuk tentang adanya endometriosis pada rektosigmoid atau kandung kencing.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 4.5pt; text-align: justify; text-indent: 31.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sigmoid doskopi dan sistoskopi dapat di memperlihatkan tempat perdarahan pada waktu haid.pembuatkan foto roentgen dengan memasukan barium dalam kolom dapat memberi gambaran dengan filling defect pada rektosigmoid dengan batas-batas yang jelas dan mukosa yang utuh. Laparoskopi merupakan pemeriksaan yang sangat berguna untuk membedakan<span> </span>dari kelainan-kelainan di pelvis. Untuk menentukan berat ringan endometriosis digunakan klasifikasi dari American fertility society.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis diferensial</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 4.5pt; text-align: justify; text-indent: 31.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adenomiosis uteri,radang pelvic dengan tumor adneks dapat menimbulkan kesukaran dalam diagnosis.pada kelainan diluar endometriosis jarang terdapat perubahan-perubahan berupa benjolan kecil di kavum douglasi dan ligamentum sakrouterinum. Kombinasi adenomiosis uteri atau mioma uteri dengan endometriosis dapat pula di temukan. Endometriosis ovary dapat menimbulkan kerusakan diagnosis diferensial dengan kista ovarium sedangkan endometriosis dari rektosigmoid perlu di bedakan dari karsinoma.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penanganan/ Pengobatan </span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 4.5pt; text-align: justify; text-indent: 31.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengobatan tergantung kepada gejala, rencana kehamilan, usia penderita dan beratnya penyakit. Obat-obatan yang dapat menekan aktivitas ovarium dan memperlambat pertumbuhan jaringan endometrium adalah diantarnya :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pil KB kombinasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">progestin</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">danazole dan agonis GnRH. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Agonis GnRH adalah zat yang pada mulanya merangsang pelepasan hormon gonadotropin dari kelenjar hipofisa, tetapis elelah diberikan lebih dari beberapa minggu akan menekan pelepasan gonadotropin.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada endometriosis sedang atau berat mungkin perlu dilakukan pembedahan. Endometriosis diangkat sebanyak mungkin, yang seringkali dilakukan pada prosedur laparoskopi. </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembedahan biasanya dilakukan pada kasus berikut: </span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -22.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Bercak jaringan endometrium memiliki garis tengah yang lebih besar dari 3,8-5 cm. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -22.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perlengketan yang berarti di perut bagian bawah atau panggul <br />
</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penangan endometriosis terdir atas pencegahan, pengawasan saja, terapi hormonal, pembedahan dan radiasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -22.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jaringan endometrium menyumbat salah satu atau kedua tuba. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -22.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jaringan endometrium menyebabkan nyeri perut atau panggul yang sangat hebat, yang tidak dapat diatasi dengan obat-obatan. Untuk membuang jaringan endometrium kadang digunakan <i>elektrokauter</i> atau sinar <i>laser</i>. Tetapi pembedahan hanya merupakan tindakan sementara, karena endometriosis sering berulang. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ovarektomi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (pengangkatan ovarium) dan <span>histerektomi</span> (pengangkatan rahim) hanya dilakukan jika nyeri perut atau panggul tidak dapat dihilangkan dengan obat-obatan dan penderita tidak ada rencana untuk hamil lagi.<span> </span>Setelah pembedahan, diberikan <span>terapi sulih estrogen</span>. Terapi bisa dimulai segera setelah pembedahan atau jika jaringan endometrium yang tersisa masih banyak, maka terapi baru dilakukan 4-6 bulan setelah pembedahan. </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pilihan pengobatan untuk endometriosis: </span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obat-obatan yang menekan aktivitas ovarium dan memperlambat pertumbuhan jaringan endometrium </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembedahan untuk membuang sebanyak mungkin endometriosis. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kombinasi obat-obatan dan pembedahan. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Histerektomi, seringkali disertai dengan pengangkatan tuba falopii dan ovarium. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 12pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 12pt; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh obat-obatan yang biasa digunakan untuk mengobati endometriosis</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border: 1pt outset rgb(0, 153, 102); width: 90%;"><tbody>
<tr> <td style="background: none repeat scroll 0% 0% rgb(153, 204, 204); border: 1pt inset rgb(0, 153, 102); padding: 3.75pt; width: 27.22%;" width="27%"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obat</span></div></td> <td style="background: none repeat scroll 0% 0% rgb(153, 204, 204); border: 1pt inset rgb(0, 153, 102); padding: 3.75pt; width: 72.78%;" width="72%"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Efek samping</span></div></td> </tr>
<tr> <td style="border: 1pt inset rgb(0, 153, 102); padding: 3.75pt; width: 27.22%;" width="27%"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pil KB kombinasi estrogen-progestin</span></div></td> <td style="border: 1pt inset rgb(0, 153, 102); padding: 3.75pt; width: 72.78%;" width="72%"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembengkakan perut, nyeri payudara, peningkatan nafsu makan, pembengkakan pergelangan kaki, mual, perdarahan diantara 2 siklus menstruasi, trombosis vena dalam </span></div></td> </tr>
<tr> <td style="border: 1pt inset rgb(0, 153, 102); padding: 3.75pt; width: 27.22%;" width="27%"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Progestin</span></div></td> <td style="border: 1pt inset rgb(0, 153, 102); padding: 3.75pt; width: 72.78%;" width="72%"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perdarahan diantara 2 siklus menstruasi, perubahan suasana hati, depresi, vaginitis atrofika</span></div></td> </tr>
<tr> <td style="border: 1pt inset rgb(0, 153, 102); padding: 3.75pt; width: 27.22%;" width="27%"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Danazole</span></div></td> <td style="border: 1pt inset rgb(0, 153, 102); padding: 3.75pt; width: 72.78%;" width="72%"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penambahan berat badan, suara lebih berat, pertumbuhan rambut, hot flashes, vagina kering, pembengkakan pergelangan kaki, kram otot, perdarahan diantara 2 siklus, payudara mengecil, perubahan suasana hati, kelainan fungsi hati, sindroma terowongan karpal</span></div></td> </tr>
<tr> <td style="border: 1pt inset rgb(0, 153, 102); padding: 3.75pt; width: 27.22%;" width="27%"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Agonis GnRH</span></div></td> <td style="border: 1pt inset rgb(0, 153, 102); padding: 3.75pt; width: 72.78%;" width="72%"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hot flashes, vagina kering, pengeroposan tulang, perubahan suasana hati</span></div></td> </tr>
</tbody></table><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengobatan dengan radiasi </span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Pengobatan ini bertujuan menghentikan fungsi ovarium tidak dilakukan lagi, kecuali jika terdapat kontra indikasi terhadap pembedahan. </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pencegahan</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 4.5pt; text-align: justify; text-indent: 31.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meigs berpendapat bahwa kehamilan adalah cara pencegahan yang paling baik untuk endometriosis. Gejal-gejala endometriosis memang berkurang atau hilang pada waktu dan sesudah kehamilan karena regresi endometrium dalam sarang-sarang endometriosis. Oleh sebab itu hendaknya perkawinan jangan ditunda terlalu lama, dan sesudah perkawinan hendaknya diusahakan supaya mendapat anak-anak yang diinginkan dalam waktu yang tidak terlalu lama. Sikap demikian itu tidak hanya merupakan profilaksis yang baik terhaap endometriosis, melainkan menghindari terjadinya infertilitas sesudah endometriosis timbul. Selain itu jangan melakukan pemeriksaan yang kasar atau melakukan kerokan pada waktu haid, hal itu dapat menyebabkan mengalirnya darh haid dari uterus ke tuba dan ke rongga panggul. </span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 4.5pt; text-align: justify; text-indent: 31.5pt;"><br />
</div></div>blog bidan aie mawarhttp://www.blogger.com/profile/01675794479695431311noreply@blogger.com0tag:blogger.com,1999:blog-8553296400543593835.post-90726364982463377502011-05-11T14:13:00.000+07:002011-05-11T14:13:33.452+07:00DIABETES PADA KEHAMILAN<div dir="ltr" style="text-align: left;" trbidi="on"><!--[if !mso]> <style>
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table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
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mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-fareast-language:EN-US;}
</style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="1027"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> <br />
<div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 16pt; line-height: 150%;"><br />
</span><span style="font-family: "Comic Sans MS"; font-size: 16pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><img align="left" height="307" hspace="12" src="file:///C:/Users/Toshiba/AppData/Local/Temp/msohtmlclip1/01/clip_image002.jpg" width="301" /><span style="font-family: "Comic Sans MS"; font-size: 16pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Penyakit gula dapat merupakan kelainan herediter dengan ciri inssufisiensi/</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">absennya insulin dalam sirkulasi darah, konsentrasi gula darah tinggi, dan berkurangnya glikogenesis. Diabetes pada kehamilan menimbulkan banyak kesulitan. Penyakit ini akan menyebabkan perubaha-perubahan metabolik dan hormonal pada penderita yang juga di pengaruhi oleh kehamilan. Sebaliknya, diabet akan mempengaruhi kehamilan dan persalinan. Frekuensi penyakit ini 0.3% s/d 0.7%. </span><span style="font-family: "Comic Sans MS"; font-size: 16pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Dugaan penyakit gula makin tinggi terjadi pada : </span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Umur penderita makin tua </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Pada multipara</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Pada penderita gemuk</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Kelahiran anak lebih besar dari 4000 gr</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Riwayat kehamilan yang mengalami : sering meninggal dalam rahim, sering mengalami lahir mati, sering mengalami keguguran. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Bersifat keturunan</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Pada pemeriksaan terdapat gula dalam urin.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Kejadian penyakit gula dalam kehamilan sering memberikan pengaruh yang kurang menguntungkan dan dapat dijabarkan sebagai berikut :</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Pengaruh penyakit gula pada kehamilan : </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Dapat terjadi gangguan pertumbuhan janin dalam rahim : terjadi keguguran, persalinan premature, kematiandalam rahim, lahir mati atau bayi besar.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Dapat terjadi hidroamnion</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Dapat menimbulkan pre-eklamsia dan eklamsia.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Pengaruh penyakit gula pada persalinan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Gangguan kontraksi otot rahim<span> </span>yang menimbulkan persalinan lama / terlantar.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Janin besar dan sering memerlukan tindakkan operasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Gangguan pembuluh darah plasenta yang menimbulkan asfiksia sampai lahir mati.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Pendarahan postpartum karena gangguan kontraksi otot rahim.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Postpartum mudah terjadi infeksi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Bayi mengalami hipoglisemia post-partum dan dapat menimbulkan kematian.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Pengaruh penyakit gula pada kala nifas</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Mudah terjadi infeksi post-partum</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Kesembuhan luka terhambat dan cenderung infeksi menyebar.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Pengaruh penyakit gula pada janin</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Dapat terjadi keguguran, persalinan premature, kematian janin dalam rahim (setelah minggu ke-36) dan lahir mati.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Bayi dengan dismaturitas</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Bayi dengan cacat bawaan </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Bayi yang potensial mengalami kelainan saraf dan jiwa.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 12pt; line-height: 150%;">Bayi yang dapat menjadi potensial mengidap penyakit gula.</span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div></div>blog bidan aie mawarhttp://www.blogger.com/profile/01675794479695431311noreply@blogger.com0tag:blogger.com,1999:blog-8553296400543593835.post-19749544996208251242011-05-07T21:37:00.000+07:002011-05-07T21:37:42.536+07:00PEMERIKSAAN FISIK BAYI BARU LAHIR NORMAL<div dir="ltr" style="text-align: left;" trbidi="on"><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>IN</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="WordSection1"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan fisik </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">merupakan pengkajian fisik yang dilakukan oleh bidan yang bertujuan untuk memastikan normalitas </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dan</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> mendeteksi adanya penyimpangan dari normal.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span> <div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian ini dapat ditemukan indikasi tentang seberapa baik bayi melakukan penyesuaian terhadap kehidupan di luar uterus dan bantuan apa yang diperlukan. Dalam pelaksanaannya harus diperhatikan agar bayi tidak kedinginan, dan dapat ditunda apabila suhu tubuh bayi rendah atau bayi tampak tidak sehat.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pelayanan kesehatan neonatal harus dimulai sebelum bayi dilahirkan, melalui pelayanan kesehatan yang diberikan kepada ibu hamil. Berbagai bentuk upaya pencegahan dan penanggulangan dini terhadap faktor-faktor yang memperlemah kondisi seorang ibu hamil perlu diprioritaskan, seperti gizi yang rendah, anemia, dekatnya jarak antar kehamilan, dan buruknya hygiene. Disamping itu perlu dilakukan pula pembinaan kesehatan prenatal yang memadai dan penanggulangan faktor-faktor yang menyebabkan kematian perinatal yang meliputi:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perdarahan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertensi </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelahiran Preterm/ bayi berat lahir rendah</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asfiksia</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipotermia</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penelitian telah menunjukkan bahwa lebih dari 50% kematian bayi terjadi dalam periode neonatal yaitu dalam bulan pertama kehidupan. Kurang baiknya penanganan bayi baru lahir yang lahir sehat akan menyebabkan kelainan-kelainan yang dapat mengakibatkan cacat seumur hidup, bahkan kematian. Misalnya sebagai akibat hipotermi pada bayi baru lahir dapat terjadi cold stress yang selanjutnya dapat menyebabkan hipoksemia atau hipoglikemia dan mengakibatkan kerusakan otak. Akibat selanjutnya adalah perdarahan otak, syok, beberapa bagian tubuh mengeras, dan keterlambatan tumbuh kembang. Contoh lain misalnya kurang baiknya pembersihan jalan napas waktu lahir dapat menyebabkan masuknya cairan lambung ke dalam paru-paru yang mengakibatkan kesulitan pernapasan, kekurangan zat asam, dan apabila hal ini berlangsung terlalu lama dapat menimbulkan perdarahan otak, kerusakan otak dan kemudian keterlambatan tumbuh kembang. Tak kurang penting adalah pencegahan terhadap infeksi yang dapat terjadi melalui tali pusat pada waktu pemotongan tali pusat, melalui mata, melalui telinga, pada waktu persalinan atau pada waktu memandikan/ membersihkan bayi dengan bahan, atau cairan atau alat yang kurang bersih. </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ditinjau dari pertumbuhan dan perkembangan bayi, periode neonatal merupakan periode yang paling kritis. Pencegahan asfiksia, mempertahankan suhu tubuh bayi, terutama pada bayi berat lahir rendah, pemberian air susu ibu (ASI) dalam usaha menurunkan angka kematian selama diare, pencegahan terhadap infeksi, pemantauan kenaikan berat badan dan stimulasi psikologis merupakan tugas pokok bagi pemantau kesehatan bayi dan anak. Neonatus pada minggu-minggu pertama sangat dipengaruhi oleh kondisi ibu pada waktu hamil dan melahirkan. Managemen yang baik pada waktu masih dalam kandungan, selama persalinan, segera setelah dilahirkan, dan pemantaun pertumbuhan dan perkembangan selanjutnya akan menghasilkan bayi yang sehat. </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian Pertama Pada Bayi Baru Lahir</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian ini dilakukan di kamar bersalin setelah bayi lahir dan setelah dilakukan pembersihan jalan nafas/resusitasi, pembersihan badan bayi, dan perawatan tali pusat. Bayi ditempatkan di atas tempat tidur yang hangat. Maksud pemeriksaan ini adalah untuk mengenal/menemukan kelainan yang perlu mendapatkan tindakan segera dan kelainan yang berhubungan dengan kehamilan, persalinan, dan kelahiran, misalnya; bayi yang lahir dari ibu dengan diabetes melitus, eklamsia berat dan lain-lain, biasanya akan mengakibatkan kelainan bawaan pada bayi. Oleh karena itu, pemeriksaan pertama pada bayi baru lahir ini harus segera dilakukan. Hal ini ditujukan untuk menetapkan keadaan bayi dan untuk menetapkan apakah seorang bayi dapat dirawat gabung atau di tempat khusus. Dengan pemeriksaan pertama ini juga bisa menentukan pemeriksaan dan terapi selanjutnya.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 1cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 14.2pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Pengkajian Fisik Pada Bayi Baru Lahir</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mendeteksi kelainan-kelainan. Pemeriksaan awal pada bayi baru lahir harus dilakukan sesegera mungkin sesudah persalinan untuk mendeteksi kelainan-kelainan dan menegakkan diagnosa untuk persalinan yang beresiko tinggi. Pemeriksaan hatrus difokuskan pada anomali kegenital dan masalah-masalah patofisiologi yang dapat mengganggu adaptasi kardiopulmonal dan metabolik normal pada kehidupan extra uteri. Pemeriksaan dilakukan lebih rinci dan dilakukan dalam 24 jam setelah bayi lahir.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mendeteksi segera kelainan dan dapat menjelaskan pada keluarga.<br />
Apabila ditemukan kelainan pada bayi maka petugas harus dapat menjelaskan kepada keluarga, karena apabila keluarga menemukannya kemudian hari, akan menimbulkan dampak yang tidak baik dan menganggap dokter atau petugas tidak bisa mendeteksi kelainan pada bayinya.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penilaian Klinik</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuannya adalah mengetahui derajat vitalitas dan mengukur reaksi bayi terhadap tindakan resusitasi. Derajat vitalitas bayi adalah kemampuan sejumlah fungsi tubuh yang bersifat esensial dan kompleks untuk berlangsungnya kelangsungan hidup bayi seperti pernapasan, denyut jantung, sirkulasi darah dan refleks- refleks primitif seperti menghisap dan mencari puting susu. Pada saat kelahiran apabila bayi gagal menunjukan reaksi vital, maka akan terjadi penurunan denyut jantung secara cepat, tubuh menjadi biru atau pucat dan refleks-refleks melemah sampai menghilang. Bila tidak segera ditangani secara tepat, cepat dan benar, keadaan umum bayi akan menurun dengan cepat dan mungkin meninggal pada beberapa bayi mungkin pulih kembali secara spontan dalam 10-30 menit sesudah lahir, tetapi bayi ini tetap mempunyai resiko tinggi untuk cacat dikemudian hari.</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1cm;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Langkah-Langkah Dalam Melakukan Pengkajian Fisik Pada Bayi Baru Lahir</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pertama, seorang petugas mengkaji keadaan umum bayi; melihat cacat bawaan yang jelas tampak seperti hidrosefal, mikrosefali, anensefali, keadaan gizi dan maturitas, aktivitas tangis, warna kulit, kulit kering/mengelupas, vernik caseosa, kelainan kulit karena fravina lahir, toksikum, tanda-tanda metonium, dan sikap bayi tidur.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Langkah kedua, pertugas melakukan pemerikasaan pada kulit. Ketidakstabilan vasomotor dan kelambatan sirkulasi perifer ditampakan oleh warna merah tua atau biru keunguan pada bayi yang menangis. Yang warnanya sangat gelap bila penutupan gloris mendahului tangisan yang kuat dan oleh sianosis yang tidak berbahaya.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada pemeriksaan kepala bisa dilihat; besar, bentuk, molding, sutura tertutup/melebar, kaput suksedanium, hematoma – sefaldan karnio tabes.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada pemeriksaan telinga dapat mengetahui kelainan daun/bentuk telinga.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada pemeriksaan mata yang bisa dinilai perdarahan sukonjugtiva, mata yang menonjol, katarak, dan lain-lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mulut dapat menilai apakah bayi; labioskisis, labioynatopalatoskisis, tooth-buds, dan lain-lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Leher; hematoma, duktis tirolusus, higromakoli.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dada; bentuk, pembesaran buah dada, pernafasan retraksi interkostal, sifoid, merintih, pernafasan cuping hidung, bunyi paru.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jantung; pulsasi, frekuensi bunyi jantung, kelainan bunyi jantung.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Abdomen; membuncit, (pembesaran hati, limpa, tumor, asites), skafoid (kemungkinan bayi mengalami hernia diafragmatika atau atresia esofagis tanpa fistula), tali pusat berdarah, jumlah pembuluh darah tali pusat, warna dan besar tali pusat, hernia di pusat atau di selangkang.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Alat kelamin; tanda-tanda hematoma karena letak sungsang, testis belum turun, fisnosis, adanya perdarahan/lendir dari vagina, besar dan bentuk klitoris dan labia minora, atresia ani.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tulang punggung; spina bifida, pilonidal sinus dan dumple.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anggota gerak; fokomeria, sindaktili, polidaktili, fraktor, paralisis talipes dan lain-lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keadaan neuramuskular; refleks moro, refleks genggam, refleks rootingdan sebagainya: tonus otot, tremor.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan lain-lain; mekonium harus keluar dalam 24 jam sesudah lahir, bila tidak harus waspada terhadap atrersia ani/obstruksi usus. Urine harus ada juga pada 24 jam. Bila tidak ada harus diperhatikan kemungkinan obstruksi saluran kencing.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 7.1pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kepala Janin Dan Ukuran-Ukurannya.</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagian yang paling keras dan besar dari janin adalah kepala janin. Posisi dan besar kepala dapat mempengaruhi jalan persalinan. Kepala juga sering mengalami cedera, sehingga dapat membahayakan hidup. Tengkorak bayi mungkin bertumpangan (molded) terutama bila bayi adalah anak pertama dan kepala telah berfiksasi beberapa waktu. Tulang parietal cenderung menumpangi tulang oksipital dan frontal. Garis sutura dan ukuran serta tekanan kontanela anterior dan posterior harus ditentukan secara digital.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 1cm;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kepala janin terdiri dari:</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a)<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagian muka</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tulang hidung (os nasake)Tulang pipi (oszygomaticum) ada dua buah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tulang rahang atas (os maxilare)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tulang rahang bawah (os mandibularis)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b)<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagian tengkorak</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagian ini yang terpenting pada persalinan karena biasanya bagian tengkoraklah yang paling depan. Yang membentuk bagian tengkorak adalah:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tulang dahi (os frontale) 2 buah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tulang ubun-ubun (os parletal) 2 buah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tulang pelipis (os temporale) 2 buah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tulang belakang kepala (os occipidale) 1 buah.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Yang penting dalam persalinan yaitu 7 tulang tersebut di atas. Diantara tulang-tulang tersebut terdapat sela tengkorak yang disebut sutura, yang mana ini membantu dalam persalinan.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kalau kepala anak tertekan pada waktu kepala bergeser/bergerak di bawah kedua tulang ubun-ubun, ini salah satu tanda untuk mengenal tulang belakang kepala pada pemeriksan dalam. Sutura dan ubun-ubun penting diketahui untuk menetukan presentasi/bagian terendah dari kepala anak dalam jalan lahir.<br />
<br />
<b><span>Macam-macam sutura yang kita kenal:</span></b></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sutura Sagitalis (sela panah) antara kedua ossa parletalis.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sutura Coronaria (sela mahkota) antara os frontale dan os parletal.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sutura Lambdoldea antara os occipitale dan kedua ossa parletal.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sutura Frontalis antara os frontale kiri kanan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ubun-ubun besar (fonticulus mayor) merupakan lubang dalam tulang tengkorak yang berbentuk segi empat dan hanya tertutup oleh selaput. Ubun-ubun besar terdapat pasa pertemuan antara 4 sutura:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 35.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sutura Sagitalis 1</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 35.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sutura Coronaria 2</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 35.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sutura Frontale 1</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 64.35pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bentuknya: <br />
sudut depan yang runcing menunjukan bagian muka anak.<br />
Susut belakang adalah tumpul. Ubun-ubun kecil (frontikulus minor)<br />
Ubun-ubun kecil terdiri dari 3 sutura:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sutura Lambdoldea 2 buah</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sutura Sagitalis 1 buah</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tulang ubun-ubun ini baru akan tertutup nanti pada anak usia 1,5 – 2 tahun.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ukuran-ukuran kepala bayi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ukuran muka belakang:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 64.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diameter sub occipitalus-bregmatica dari foramen magnum ke ubun-ubun besar 29,5 cm.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 64.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diameter sub occipito frontalis: (dari foramen magnum ke pangkal hidung).11 cm.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 64.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diameter fronto occipitalis (dar pangkal hidung ke titik yang terjadi pada belakang kepala. 12 cm.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 64.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diameter mento occipitalis (dari dagu ke titik yang terjauh pada belakang kepala).<span> </span>13,5 bertugas.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 64.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diameter sub mento bragmatika (dari bawah dagu ke ubun-ubun besar) <span> </span>9 cm.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ukuran lingkaran:</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Circumferentia sub occiput bregmatika. (lingkaran kecil kepala) 31 cm.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Circumferentia fronto occipitalis (lingkaran sedang kepala) <span> </span>34 cm.<br />
3. Circumferentia mento occipitalis (lingkaran besar kepala). 35 cm. </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Prinsip pemeriksaan bayi baru lahir</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jelaskan prosedur pada orang tua dan minta persetujuan tindakan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cuci dan keringkan tangan , pakai sarung tangan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pastikan pencahayaan baik</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Periksa apakah bayi dalam keadaan hangat, buka bagian yangg akan diperiksa (jika bayi telanjang pemeriksaan harus dibawah lampu pemancar) dan segera selimuti kembali dengan cepat</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-GB" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Periksa bayi secara sistematis dan menyeluruh</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">P</span></b><b><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">rosedur</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><ol start="1" type="1"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jelaskan pada ibu dan keluarga maksud dan tujuan dilakukan pemeriksaan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lakukan anamnesa riwayat dari ibu meliputi faktor genetik, faktor lingkungan, sosial,faktor ibu (maternal),faktor perinatal, intranatal, dan neonatal</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Susunalat secara ergonomis </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cuci tangan menggunakan sabun dibawah air mengalir, keringkan dengan handuk bersih</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memakai sarung tangan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Letakkan bayi pada tempat yang rata</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></li>
</ol><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengukuran Anthopometri</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><ol start="1" type="1"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penimbangan berat badan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Letakkan kain atau kertas pelindung dan atur skala penimbangan ke titik nol sebelum penimbangan. Hasil timbangan dikurangi berat alas dan pembungkus bayi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><ol start="2" type="1"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengukuran panjang badan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Letakkan bayi di tempat yang datar</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ukur panjang badan dari kepala sampai tumit dengan kaki/badan bayi diluruskan. Alat ukur harus terbuat dari Ukur lingkar kepala</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. </span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengukuran dilakukan dari dahi kemudian melingkari kepala kembali lagi ke dahi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><ol start="4" type="1"><li class="MsoNormal" style="line-height: normal; text-align: justify;"><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Ukur lingkar dada</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">. </span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt;">ukur lingkar dada dari daerah dada ke punggung kembali ke dada (pengukuran dilakukan melalui kedua puting susu)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></li>
</ol><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penanganan Bayi Baru Lahir</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan utama perawatan bayi segera sesudah lahir, ialah:<span> </span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 49.65pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Membersihkan jalan nafas</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 49.65pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memotong dan merawat tali pusat</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 49.65pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mempertahankan suhu tubuh bayi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 49.65pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identifikasi</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 49.65pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pencegahan infeksi</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembersihan jalan napas, perawatan tali pusat, perawatan mata dan identifikasi adalah rutin segera dilakukan, kecuali bayi dalam keadaan kritis, dan dokter memberi intruksi khusus. </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Membersihkan jalan nafas</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi normal akan menangis spontan segera setelah lahir. Apabila bayi tidak langsung menangis, penolong segera membersihkan jalan napas dengan cara sebagai berikut:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 49.65pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Letakkan bayi pada posisi terlentang di tempat yang keras dan hangat</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 49.65pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gulung sepotong kain dan letakkan di bawah bahu sehingga leher bayi lebih lurus dan kepala tidak menekuk. Posisi kepala diatur lurus sedikit tengadah ke belakang</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 49.65pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bersihkan hidung, rongga mulut dan tenggorokan bayi dengan jari tangan yang dibungkus kasa steril</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 49.65pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tepuk kedua telapak kaki bayi sebanyak 2-3 kali atau gosok kulit bayi dengan kain kering dan kasar. Dengan rangsangan ini biasanya bayi segera menangis.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 70.9pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>¯<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kekurangan zat asam pada bayi baru lahir dapat menyebabkan kerusakan otak . Sangat penting membersihkan jalan napas, sehingga upaya bayi bernapas tidak akan menyebabkan aspirasi lendir (Masuknya lendir ke paru-paru).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 3cm; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Alat pengisap lendir mulut (DeLee) atau alat pengisap lainnya yang steril, tabung oksigen dengan selngnya harus telah siap di tempat.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 3cm; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Segera lakukan usaha mengisap mulut dan hidung</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 3cm; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Petugas harus memantau dan mencatat usaha napas yang pertama </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 3cm; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Warna kulit, adanya cairan atau mekonium dalam hidung atau mulut harus diperhatikan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.8pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>¯<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bantuan untuk memulai pernapasan mungkin diperlukan untuk mewujudkan ventilasi yang adekuat</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 3cm; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>F<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dokter atau tenaga medis lain hendaknya melakukan pemompaan bila setelah 1 menit bayi tak bernapas.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memotong dan Merawat Tali Pusat</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tali pusat dipotong sebelum atau sesudah plasenta lahir tidak begitu menemukan dan tidak akan mempengaruhi bayi, kecuali pada bayi kurang bulan. Apabila bayi lahir tidak menangis, maka tali pusat segera dipotong untuk memudahan melakukan tindakan resusitasi pada bayi. Tali pusat dipotong 5 cm dari dinding perut bayi dengan gunting steril dan diikat dengan pengikat steril. Apabila masih terjadi perdarahan dapat dibuat ikatan baru. Luka tali pusat dibersihkan dan dirawat dengan alkohol 70% atau podivon iodin 10% serta dibalut kasa steril. Pembalut tersebut diganti setiap hari dan atau setiap tali basah atau kotor.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sebelum memotong tali pusat, dipastikan<span> </span>bahwa tali pusat telah di klem dengan baik, untuk mencegah terjadinya perdarahan. Membungkus ujung potongan tali pusat adalah kerja tambahan.</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 53.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Alat pengikat tali pusat tau klem harus selalu siap tersedia di ambulans, di kamar bersalin, ruang penerima bayi dan ruang perawatan bayi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 53.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gunting steril juga siap</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 53.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau kemungkinan terjadinya perdarahan dari tali pusat.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mempertahankan suhu tubuh bayi</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada waktu baru lahir, bayi belum mampu mengatur tetap suhu suhu badannya, dan membutuhkan pengaturan dari luar untuk membuatnya tetap hangat. Bayi baru lahir harus di bungkus hangat. Suhu tubuh bayi merupakan tolok ukur kebutuhan akan tempat tidur yang hangat sampai suhu tubuhnya sudah stabil. Suhu bayi harus di catat.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memberi Vitamin K</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejadian perdarahan karena defisiensi vitamin K pada bayi baru lahir dilaporkan cukup tinggi, berkisar 0,25-0,5%. Untuk ,mencegah terjadinya perdarahan tersebut, semua bayi baru lahir normal dan cukup bulan perlu diberi vitamin K peroral 1 mg/hari selama 3 hari, sedangkan bayi resiko tinggi diberi vitamin K parenteral dengan dosis 0,5-1 mg I.M.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memberi Obat tetes/ salep mata </span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dibberapa negara perawatan mata bayi baru lahir secara hukum diharuskan untuk mencegah terjadinya oftalmia neonatorum. Di daerah mana prevalensi gonorea tinggi, setiap bayi baru lahir perlu diberi salep mata sesudah 5 jam bayi lahir. Pemberian obat mata eritromisin 0,5% atau tetrasiklin 1% dianjurkan untuk pencegahan penyakit mata karena klamidia (penyakit menular seksual).</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perawatan mata harus dikerjakan segera. Tindakan ini dapat dikerjakan setelah bayi selesai dengan perawatan tali pusat dan harus dicatat di dalam status termasuk obat apa yang digunakan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Yang lazim dipakai adalah larutan Perak Nitrat atau Neosporin dan langsung diteteskan pada mata bayi segera setelah bayi lahir.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>¯<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peralatan untuk perawatan mata harus siap diruang penerimaan/ persali nan, ruang rawat bayi, termasuk:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 3cm; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obat-obatan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 3cm; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perlengkapan berisi:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 106.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Alat tetes mata</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 106.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gelas obat kecil steril dan kapas</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 3cm; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cairan NaCl untuk irigasi mata (bila yang dipakai Perak Nitrat)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>¯<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan warna dari cairan penetes baru telah terjadi perubahan kimia, sehingga tak dapat dipakai lagi.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 3cm; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Petugas hendaknya secara rutin meneliti terjadinya perubahan warna pada cairan obat yang dipakai atau adanya kristal yang timbul yang mungkin terjadi apabila suhu ruangan melebih 34°C.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identifikasi bayi</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apabila bayi dilahirkan di tempat bersalin yang persalinanya mungkin lebih dari satu persalinan, maka sebuah alat pengenal yang efektif harus diberikan kepada setiap bayi baru lahir dan harus tetap di tempatnya sampai waktu bayi dipulangkan.</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 49.65pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peralatan identifikasi bayi baru lahir harus selalu tersedia ditempat penerimaan pasien, di kamar bersalin, dan di ruang rawat bayi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 49.65pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Alat yang digunakan, hendaknya kebal air, dengan tepi yang halus tidak mudah melukai, tidak mudah sibuk , dan tidak mudah lepas.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 49.65pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada alat/gelang identifikasi harus tercantum:</span></div></div><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: auto;" /> </span> <div class="WordSection2"> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 92.15pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nama,(bayi, nyonya)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 92.15pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanggal lahir,</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 92.15pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nomor bayi,</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 92.15pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jenis kelamin,</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 92.15pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Unit,</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 92.15pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>§<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nama lengkap ibu</span></div></div><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: auto;" /> </span> <div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 21.3pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 49.65pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di setiap tempat tidur harus diberi tanda tangan dengan mencntumkan nama, tanggal lahir, nomor dentifikasi.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sidik telapak kaki bayi dan sidik jari ibu harus di cetak di catatan yang tidak mudah hilang. Sidik telapak kaki bayi harus dibuat dengan personil yang berpengalaman menerapkan cara ini, dan dibuat dalam catatan bayi. Bantalan sidik kaki harus disimpan dalam ruangan bersuhu kamar.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ukurlah berat lahir, panjang bayi, lingkar kepala, lingkar perut dan cacat dalam rekam medik.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemantauan bayi baru lahir</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan pemantauan bayi baru lahir adalah untuk mengetahui aktivitas bayi normal atau tidak dan identivikasi masalah kesehatan bayi baru lahir yang memerlukan perhatian keluarga dan penolong persalinan serta tindak lanjut petugas kesehatan.</span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dua jam pertama setelah lahir</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hal-hal yang dinilai waktu pemantauan bayi pada jam pertama sesudah lahir meliputi:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kemampuan menghisap kuat atau lemah</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi tampak aktif atau lunglai</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi kemerahan atau biru</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 42.55pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sebelum penolong persalinan meninggalkan ibu dan bayinya</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penolong persalinan melakukan pemeriksaan dan penilaian terhadap ada tidaknya masalah kesehatan yang memerlukan tindak lanjut, seperti:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi kecil untuk masa kehamilan atau bayi kurang bulan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan pernapasan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipotermia</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cacat bawaan dan Trauma lahir</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 42.55pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Yang Perlu Dipantau Pada Bayi Baru Lahir</span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Suhu badan dan lingkungan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda-tanda vital</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berat badan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mandi dan perawatan kulit</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pakaian</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perawatan tali pusar</span></div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemantauan tanda-tanda vital</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Suhu tubuh bayi diukur melalui dubur atau ketiak</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada pernafasan normal perut dan dada bergerak hampir bersamaan tanpa adanya retraksi, tanpa terdengar suara pada waktu inspirasi maupun ekspirasi. Gerak pernafasan 30-50 kali per menit.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nadi dapat dipantau disemua titik-titik nadi perifer</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tekanan darah dipantau hanya bila ada indikasi.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mencatat hasil pantauan merupakan salah satu cara kerja sama seluruh tim dalam membuat program perawatan. Pencegahan lebih bermanfaat dan ekonomis dari pada pengobatan.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penilaian Bayi Untuk Tanda-Tanda Kegawatan</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Semua bayi baru lahir harus dinilai<span> </span>adanya tanda-tanda kegawatan/kelainan yang menunjukan adanya suatu penyakit.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi baru lahir dinyatakan sakit apabila mempunyai salah satu atau beberapa tanda-tanda berikut:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sesak napas</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Frekuensi pernapasan 60 kali/menit</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gerak retraksi di dada</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Malas minum</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Panas/suhu badan bayi rendah</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurang aktif</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berat lahir rendah (1499-2499 gram) dengan kesulitan minum</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda-tanda bayi sakit berat</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apabila terdapat salah satu atau lebih tanda-tanda berikut:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sulit minum</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sianosis sentral (lidah biru)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perut kembung</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Periode apneu</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang atau periode kejang-kejang kecil</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Merintih</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perdarahan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sangat kuning</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berat badan lahir kurang dari 1500 gram</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><br />
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</style> <![endif]--> <div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">DAFTAR PUSTAKA</span></b></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Prawiroharjo, S. 2009. <i>Pelayanan Kesehatan Maternal dan Neonatal, </i>Edisi V. PT.Bina Pustaka Sarwono Prawirohardjo: Jakarta. Hal. 132-139</span></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Alimulhidayat, Aziz. 2008. <i>Ilmu Kesehatan Anak</i>. Salemba Medika: Surabaya</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><br />
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</div></div>blog bidan aie mawarhttp://www.blogger.com/profile/01675794479695431311noreply@blogger.com1tag:blogger.com,1999:blog-8553296400543593835.post-52667654819784659562011-04-21T13:13:00.001+07:002011-04-21T13:52:37.916+07:00<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left;"><b>SEJARAH KEBIDANAN DI MASA LAMPAU</b></div><div></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Di Mesir kuno, kebidanan adalah pekerjaan perempuan yang diakui, seperti yang dibuktikan oleh papirus yang berasal Ebers 1900-1550 SM. Lima kolom papirus ini berhubungan dengan kebidanan dan ginekologi, terutama mengenai percepatan proses kelahiran dan kelahiran bayi yang baru lahir prognosis. The Westcar papirus, tanggal sampai 1700 SM, termasuk instruksi untuk menghitung perkiraan tanggal kurungan dan menggambarkan gaya yang berbeda kelahiran kursi. Bas relief di kamar kelahiran kerajaan di Luxor dan candi-candi lain juga membuktikan kehadiran berat kebidanan dalam budaya ini.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Kebidanan di Yunani-Romawi kuno meliputi sejumlah wanita, termasuk wanita-wanita tua yang meneruskan tradisi medis rakyat di desa-desa Kekaisaran Romawi, bidan terlatih pengetahuan mereka yang dikumpulkan dari berbagai sumber, dan sangat terlatih perempuan yang dianggap dokter wanita.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Namun, ada karakteristik tertentu yang diinginkan dalam suatu “baik” bidan, seperti yang dijelaskan oleh dokter Soranus Efesus di abad kedua. Dia menyatakan dalam karyanya, Ginekologi, bahwa “orang yang sesuai akan melek, dengan akal tentang dia, memiliki ingatan yang baik, mencintai pekerjaan, terhormat dan umumnya tidak terlalu cacat sebagai indranya regards [yaitu, penglihatan, penciuman, pendengaran ], suara ekstremitas, kuat, dan, menurut beberapa orang, diberkahi dengan jari-jarinya ramping panjang dan pendek kuku di ujung-ujung jarinya. “Soranus juga merekomendasikan bahwa bidan menjadi simpatik disposisi (walaupun dia tidak perlu melahirkan anak sendiri) dan bahwa ia menjaga tangannya lembut untuk kenyamanan ibu dan anak.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Pliny, dokter lain dari zaman ini, bernilai Kemuliaan dan yang tenang dan tak mencolok disposisi dalam bidan.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Seorang perempuan yang memiliki kombinasi fisik, kebajikan, keterampilan, dan pendidikan pasti sudah sulit ditemukan di jaman dahulu. Oleh karena itu, tampaknya telah tiga “nilai” dari bidan hadir di zaman kuno. Yang pertama adalah ahli teknis, yang kedua mungkin telah membaca beberapa teks pada kebidanan dan ginekologi, tetapi yang ketiga sangat terlatih dan cukup dianggap sebagai dokter spesialis dengan konsentrasi di kebidanan.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Bidan yang dikenal dengan berbagai judul di zaman kuno, mulai dari iatrinē, maia, obstetrix, dan MEDICA.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Tampaknya kebidanan diperlakukan berbeda di ujung Timur Laut Tengah baskom sebagai lawan Barat. Di Timur, beberapa wanita maju di luar profesi bidan (maia) dengan yang dokter kandungan (iatros gynaikeios), yang diperlukan pelatihan formal. Juga, ada beberapa traktat kebidanan beredar di kalangan medis dan berpendidikan dari Timur yang ditulis oleh perempuan dengan nama Yunani, walaupun wanita ini sangat sedikit jumlahnya. Berdasarkan fakta-fakta ini, akan terlihat bahwa kebidanan di Timur terhormat adalah profesi yang terhormat perempuan bisa mendapatkan mata pencaharian mereka dan cukup harga diri untuk menerbitkan karya membaca dan dikutip oleh dokter laki-laki. Pada kenyataannya, sejumlah ketentuan hukum Romawi sangat menyarankan bahwa bidan menikmati status dan upah yang setara dengan laki-laki dokter. [5] Satu contoh dari bides yang dikutip dari Salpe Lemnos, yang menulis tentang penyakit wanita dan disebutkan beberapa kali dalam karya Pliny.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Namun, di Romawi Barat, pengetahuan kita tentang cara mempraktekkan bidan datang terutama dari epitaphs penguburan. Dua hipotesis yang diusulkan dengan melihat sampel kecil epitaphs ini. Yang pertama adalah bidan bukanlah profesi yang freeborn keluarga perempuan yang telah menikmati status bebas dari beberapa generasi tertarik; oleh karena itu tampaknya bahwa sebagian besar bidan adalah dari budak asal. Kedua, karena sebagian besar epitaphs pemakaman ini menggambarkan perempuan sebagai dibebaskan, maka dapat diusulkan bahwa bidan umumnya cukup dihargai, dan memperoleh pendapatan yang cukup, untuk bisa mendapatkan kebebasan mereka. Tidak diketahui dari epitaphs ini bagaimana perempuan budak tertentu dipilih untuk pelatihan sebagai bidan. Gadis budak mungkin telah magang, dan kemungkinan besar bahwa ibu mengajarkan anak-anak perempuan mereka.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Sebenarnya tugas para bidan di zaman kuno terutama terdiri dari membantu proses kelahiran, meskipun mereka dapat juga membantu dalam masalah-masalah medis lainnya yang berhubungan dengan wanita jika diperlukan. Sering kali, bidan juga akan memanggil dokter yang akan on-call dengan dia di dalam kasus yang lebih sulit prosedur yang dibutuhkan selama persalinan abnormal dan dalam kebanyakan kasus ia membawa dua atau tiga asisten.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Pada zaman kuno, hal itu percaya oleh kedua bidan dan dokter yang melahirkan normal dibuat lebih mudah ketika seorang wanita duduk tegak. Oleh karena itu, selama proses kelahiran, bidan membawa bangku ke rumah di mana pengiriman berlangsung. Di kursi kursi adalah lubang berbentuk bulan sabit di mana bayi akan disampaikan. Kursi juga memiliki lengan kursi bagi ibu untuk pegang selama pengiriman. Sebagian besar kursi yang telah punggung pasien bisa menekan, tapi Soranus menunjukkan bahwa dalam beberapa kasus, kursi-kursi asisten backless dan harus berdiri di belakang pasien dan dukungan padanya.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Bidan lalu menghadap pasien, lembut dilatasi dan menarik janin ke depan, sambil memerintahkan para ibu pada pernapasan dan bagaimana untuk mendorong ke bawah selama kontraksi. Asisten membantu dengan mendorong ke bawah pada perut pasien. Akhirnya, bidan menerima bayi, meletakkannya di potongan-potongan kain, memotong tali pusat, dan dibersihkan bayi.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Anak itu ditaburi dengan “halus dan tepung garam, atau natron atau aphronitre” untuk menyerap residu kelahiran , dibilas, dan kemudian bubuk dan dibilas lagi. Selanjutnya, para bidan dibersihkan setiap dan semua hadir lendir dari hidung, mulut, telinga, atau anus. Bidan didorong oleh Soranus untuk menaruh minyak zaitun di mata bayi untuk membersihkan diri setiap kelahiran residu, dan untuk menempatkan sepotong wol direndam dalam minyak zaitun di atas tali pusar. Setelah melahirkan, bidan panggilan pertama dibuat pada apakah atau tidak seorang bayi sehat dan cocok untuk belakang. Dia memeriksa bawaan bayi yang baru lahir cacat dan pengujian yang menangis mendengar apakah atau tidak itu kuat dan ramah. Pada akhirnya, bidan membuat penentuan tentang peluang untuk kelangsungan hidup bayi dan kemungkinan merekomendasikan agar bayi yang baru lahir dengan cacat parah terkena.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Abad kedua terakota Ostian bantuan dari makam Scribonia Attice, istri dokter-dokter bedah M. Ulpius Amerimnus, detail sebuah adegan melahirkan. Scribonia adalah seorang bidan dan lega menunjukkan dirinya di tengah-tengah pengiriman. Seorang pasien duduk di kursi bersalin, mencengkeram pegangan dan asisten bidan berdiri di belakang memberikan dukungan. Scribonia duduk di bangku rendah di depan wanita, merendah memalingkan muka sementara juga membantu pengiriman oleh dilatasi dan memijat leher rahim, seperti yang didorong oleh Soranus.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Jasa bidan tidak murah; kenyataan ini menunjukkan bahwa perempuan miskin yang tidak mampu jasa bidan profesional sering harus membuat hubungannya dengan saudara perempuan. Banyak keluarga kaya memiliki bidan mereka sendiri. Namun, sebagian besar perempuan di dunia Yunani-Romawi sangat mungkin menerima perawatan bersalin dari menyewa bidan, baik yang sangat terlatih atau yang memiliki pengetahuan dasar kebidanan. Selain itu, banyak keluarga memiliki pilihan apakah atau tidak mereka ingin mempekerjakan seorang bidan yang terlatih obat rakyat tradisional atau metode baru proses kelahiran profesional.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Seperti banyak faktor lain di zaman kuno, seringkali perawatan kebidanan berkualitas sangat bergantung kepada status sosial ekonomi pasien.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left;"><b>Perspektif sejarah</b></div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Pada abad ke-18, sebuah divisi antara dokter dan bidan muncul, sebagai orang medis mulai menegaskan bahwa proses ilmiah modern mereka adalah lebih baik bagi ibu dan bayi daripada kaum-medis bidan.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Pada awal abad ke-18 di Inggris, kebanyakan bayi tertangkap oleh bidan, tetapi pada awal abad ke-19, sebagian besar bayi-bayi yang lahir pada orang-orang berarti memiliki ahli bedah yang terlibat. Sejumlah penelitian baik panjang penuh bersejarah ini pergeseran telah ditulis.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Ilmuwan sosial Jerman Gunnar Heinsohn dan Otto Steiger sudah mengajukan teori bahwa kebidanan menjadi sasaran penganiayaan dan penindasan oleh otoritas publik, karena bidan tidak hanya dimiliki sangat khusus tentang pengetahuan dan keterampilan yang membantu kelahiran, tapi juga mengenai kontrasepsi dan aborsi. [11] Menurut untuk Heinsohn dan Steiger teori, negara modern menganiaya bidan sebagai penyihir dalam usaha untuk terisi kembali benua Eropa yang mengalami kerugian parah tenaga kerja sebagai hasil dari pes (juga dikenal sebagai kematian hitam) yang menyapu benua gelombang, mulai tahun 1348.</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Mereka demikian menafsirkan perburuan penyihir sebagai menyerang kebidanan dan pengetahuan tentang pengendalian kelahiran dengan tujuan demografis dalam pikiran. Memang, setelah penyihir perburuan, jumlah anak per ibu meningkat tajam, sehingga menimbulkan apa yang disebut “ledakan penduduk Eropa” modern kali, menghasilkan tonjolan pemuda yang sangat besar yang memungkinkan Eropa untuk menjajah sebagian besar sisa dunia.</div><div style="text-align: left;"><span style="font-family: "Calibri","sans-serif"; font-size: 11pt; line-height: 115%;"></span><br />
<span style="font-family: "Calibri","sans-serif"; font-size: 11pt; line-height: 115%;"> </span> </div><div class="MsoNormal" style="text-align: left;"><br />
</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left;"><b>SEJARAH KEBIDANAN</b></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pelayanan kebidanan adalah seluruh tugas yang menjadi tanggung jawab profesi bidan dalam sistem pelayanan kesehatan yang bertujuan untuk meningkatkan kesehatan kaum perempuan khususnya ibu dan anak. Bidan di dalam menjalankan peran, fungsi dan tugasnya didasarkan pada kemampuan dan kewenangan yang diberikan. Seorang bidan haruslah tahu siapa saja yang mempelopori perkembangan kebidanan.</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 36pt;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 36pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PELOPOR KEBIDANAN DARI LUAR NEGERI</span></b></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 36pt;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hyppocrates (460-370 SM)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hyppocrates yang berkebangsaan Yunani, dikenal sebagai Bapak Pengobatan, tidak lain karena jasa-jasanya dalam bidang keperawatan, kedokteran, dan pengobatan. Dalam bidang kebidanan Hyppocrates menganjurkan agar wanita yang sedang melahirkan harus ditolong berdasarkan perikemanusiaan dengan cara meringankan beban ibu yang sedang bersalin itu.</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
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</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">William Shippman (1736-1808)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dokter berkebangsaan Amerika ini mendirikan kursus kebidanan dan rumah sakit bersalin, pada tahun 1762. Kemudian pada tahun 1810 bersama dokter Thomas Chaalkley mempromosikan partus buatan pada bayi premature pada ibu yang pinggulnya sempit.</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dr. Sammuel Bard (1742-1821)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dr. Samuel Bard, yang berkebangsaan Amerika Serikat banyak menulis buku-buku kebidanan, diantaranya :</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: left; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.</span><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cara pengukuran konyugata diagonalis</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: left; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.</span><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan-kelainan pinggul</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: left; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.</span><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Melarang pemeriksaan dalam apabila tidak ada indikasi</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: left; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.</span><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Membagi persalinan pada empat kala</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: left; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e.</span><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menasehatkan jangan menarik tali pusat untuk mencegah terjadinya inversio uteri</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: left; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">f.</span><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengajarkan bahwa letak muka dapat lahir spontan</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: left; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">g.</span><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Melarang pemakaian cunam yang berulang-ulang karena banyak menimbulkan kerugian.</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dr. Walter Channing (1786-1876)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Channing memperoleh gelar dokter pertama kali dari Universitas Edinburg. Ia adalah professor kebidanan dan hukum kedokteran pertama yang diperoleh dari Universitas Harvard. Ia adalah salah satu dokter yang pertama kali menggunakan anesthesia (bius) kepada ibu yang melahirkan, dan ia membuat risalah untuk kepentingan itu, diberi judul “Treatise on Etherization in Child Birth, illustrated by 581 cases”, tahun 1849.</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dr. Boudeloque (1745-1810)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ia adalah ahli kebidanan yang meneliti dan mempelajari tentang panggul dan ukurannya. Ia menerbitkan buku pada tahun 1842, yakni panggul sebagai basis dalam kebidanan, persalinan dapat dilakukan dengan cara sikap dorsol recumbent, ketentuan pemasangan forcep kepala jangan lebih dari 6 jam didasar panggul.</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">6.</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hugh L. Hodge, M.D. (1796-1873)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nama lengkapnya Hugh Lenox Hodge. Ia adalah dokter berkebangsaan Amerika, dilahirkan di Philadelphia, pada tanggal 27 bulan juni tahun 1796, memperoleh gelar dokter dari Univearsitas Pennsylvania.</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ia mempelajari letak belakang kepala, mekanisme letak sungsang, pemasangan forcep harus di samping kepala anak kecuali bila kepala masih tinggi, membagi turunnya kepala dengan bidang-bidang dasar panggul. Di samping itu ia menulis buku yang terkenal pada tahun 1866, yakni “The Principle and Practice of Obstertrics”. Buku ini terkenal di Amerika dan di luar Amerika, diterbitkan oleh Thomas Sinclair dari Philadelphia.</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">7.</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Francois Mauriceau (1637-17 Oktober 1709)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ia adalah ahli kebidanan (obstertrician) berkebangsaan Perancis abad 17 yang terkenal di Eropa. Pertama kali bukunya yang terbit adalah “Traite des Maladies des femmes Grosses et Accouchees”, adalah satu buku yang membangun obstertrics (ilmu kebidanan) sebagai suatu ilmu, yang kemudian diterjemahkan ke dalam berbagai bahasa di dunia. Ia juga terkenal di dalam mengembangkan metoda kuno di dalam membantu kelahiran sunsang. Ia memberikan gambaran mengenai kehamilan tuba dan bersama dengan bidan dari Jerman, Justine Siegmundin (1650-1705) mendapat penghargaan karena mengenalkan praktek punksi (punctio) kantong selaput ketuban (amnion) guna menahan pendarah di placenta praevia, yakni plasenta yang tumbuh pada segmen rahim, yaitu pada daerah dilatasi, sehingga menutupi ostium internum servisis uteri; gejala utama plasenta praevia adalah pendarahan tanpa rasa nyeri pada kehamilan trisemester terakhir, khususnya selama bulan kedelapan.</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada awal abad 18, seorang ahli kebidanan Inggris Hugh Chamberlen mencoba menjual forceps “rahasia” khusus untuk obstetric kepada Mauriceau. Mauriceau menjadi benci kepada Chamberlen yang menuduhnya bahwa keluarga Chamberlen biasa menipu.</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">8.</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ignaz Philipp Semmelweis (1 Juli 1818-13 Agustus 1865)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ia adalah dokter dari Hungaria yang mendapat julukan “savior of mothers” artinya penyelamat kaum ibu. Hal itu karena dalam penelitiannya ia menemukan cara menyelamatkan ibu-ibu yang mengalami demam saat masa nifas, karena infeksi, (sepsis puerpuerium) dapat diatasi secara cepat dengan tekhnik cuci tangan yang akurat berdasarkan standar kedokteran di dalam klinik kebidanan.</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ia pada tahun 1847, mengenalkan teknik cuci tangan menggunakan cairan kapur-klor atau kapur terklorinasi (lime chlorinate solutions=kaporit), kepada mahasiswa kedokteran residen yang sudah praktek autopsy. Teknik cuci tangan seperti ini dalam prakteknya saat itu dapat segera mengurangi demam nifas yang fatal dari 10% sampai 12%. Dasar teori ini kelak menjadi dasar dari penelitian Louis Pasteur yang emngembangkan teori penyebab penyakit karena mikroorganisme pantogen. Semmelweis kemudian dipandang sebagai pelopor prosedur antiseptis.</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">9.</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 7pt; line-height: 150%;"> </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Daunce dari Bordeaux</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada tahun 1857 ia memperkenalkan pembangunan incubator dalam perawatan bayi premature. Setelah abad 20 dikembangkanlah post natal care dengam ambulasi dini, roming in mulai dipraktikan, monitoring antepartum dan ingtrapartum yang tepat dengan penggunaan ultrasonografi dan cardiotocgrafi</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PELOPOR KEBIDANAN DI DALAM NEGERI</span></b></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pendidikan bidan dimulai pada masa penjajahan Hindia Belanda. Pada tahun 1851 seorang dokter militer Belanda (Dr. W. Bosch) membuka pendidikan bidan bagi wanita pribumi di Batavia. Pendidikan ini tidak berlangsung lama karena kurangnya peserta didik yang disebabkan karena adanya larangan maupun pembatasan bagi wanita untuk keluar rumah.</span></div><div style="text-align: left;"></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left;"><b>WEWENANG BIDAN</b></div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;">Sesuai Keputusan Menteri Kesehatan RI No.900/ Menkes/SK/VII/2002. Bidan dalam menjalankan praktik profesinya berwenang untuk memberikan pelayanan yang meliputi:</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;"><b>1.<span style="font: 7pt "Times New Roman";"> </span></b><b>Pelayanan Kebidanan kepada Ibu pada masa pranikah, prahamil, masa kehamilan, masa persalinan, masa nifas, menyusui, meliputi:</b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 42.55pt; text-align: left; text-indent: -18pt;">a.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Penyuluhan dan konseling</span></i></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 42.55pt; text-align: left; text-indent: -18pt;">b.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Pelayanan kebidanan kepada ibu meliputi</span></i>:</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 63.8pt; text-align: left; text-indent: -18pt;">1)<span style="font: 7pt "Times New Roman";"> </span>Penyuluhan dan konseling</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 63.8pt; text-align: left; text-indent: -18pt;">2)<span style="font: 7pt "Times New Roman";"> </span>Pemeriksaan fisik</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 63.8pt; text-align: left; text-indent: -18pt;">3)<span style="font: 7pt "Times New Roman";"> </span>Pelayanan antenatal pada kehamilan abnormal</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 63.8pt; text-align: left; text-indent: -18pt;">4)<span style="font: 7pt "Times New Roman";"> </span>Pertolongan pada kehamilan abnormal yang mencakup abortus imminens, Hiperemesis gravidarum tingkat I, pre eklampsia ringan dan anemia ringan.</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 63.8pt; text-align: left; text-indent: -18pt;">5)<span style="font: 7pt "Times New Roman";"> </span>Pertolongan persalinan normal</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 63.8pt; text-align: left; text-indent: -18pt;">6)<span style="font: 7pt "Times New Roman";"> </span>Pertolongan persalinan abnormal, yang mencakup letak sungsang, partus macet kepala di dasar panggul, ketuban pecah dini (KPD) tanpa infeksi, perdarahan post partum, laserasi jalan lahir, distosia karena inersia uteri, post term dan pre term.</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 63.8pt; text-align: left; text-indent: -18pt;">7)<span style="font: 7pt "Times New Roman";"> </span>Pelayanan ibu nifas normal. Pelayanan ibu nifas abnormal yang mencakup retensio plasenta dan infeksi ringan.</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 63.8pt; text-align: left; text-indent: -18pt;">8)<span style="font: 7pt "Times New Roman";"> </span>Pelayanan dan pengobatan pada kelainan ginekologi yang mengalami keputihan, perdarahan tidak teratur dan penundaan haid.</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 42.55pt; text-align: left; text-indent: -18pt;">c.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Pelayanan kebidanan pada anak, meliputi:</span></i></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 78.55pt; text-align: left; text-indent: -18pt;"><i><span style="font-style: normal;">1)<span style="font: 7pt "Times New Roman";"> </span></span></i><i><span style="font-style: normal;">Pemeriksaan bayi baru lahir</span></i><i><span style="font-style: normal;"></span></i></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 78.55pt; text-align: left; text-indent: -18pt;">2)<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Perawatan tali pusat</span></i></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 78.55pt; text-align: left; text-indent: -18pt;">3)<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Perawatan bayi: 0–28 hari termasuk ASI eksklusif s/d 6 bulan</span></i></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 78.55pt; text-align: left; text-indent: -18pt;">4)<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Resusitasi pada bayi baru lahir dengan asfiksia</span></i></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 78.55pt; text-align: left; text-indent: -18pt;">5)<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Pemantauan tumbuh kembang anak</span></i></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 78.55pt; text-align: left; text-indent: -18pt;">6)<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Pemberian imunisasi</span></i></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 78.55pt; text-align: left; text-indent: -18pt;">7)<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Pemberian penyuluhan</span></i></div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left; text-indent: 1cm;"><b>Selain itu bidan berwenang pula untuk:</b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">a.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Memberikan imunisasi</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">b.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Memberikan suntikan pada penyulit kehamilan, persalinan, dan nifas</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">c.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Mengeluarkan plasenta secara manual</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">d.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Memberikan bimbingan senam hamil</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;"><i><span style="font-style: normal;">e.<span style="font: 7pt "Times New Roman";"> </span></span></i><i><span style="font-style: normal;">Pengeluaran sisa jaringan konsepsi</span></i></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">f.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Episiotomi jika diperlukan</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">g.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Penjahitan luka episiotomi dan luka jalan lahir sampai grade II</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">h.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Melakukan amniotomi</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">i.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Memberikan infus</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">j.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Memberikan suntikan intra muskular uterotonika, antibiotika dan sedativa</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">k.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Melakukan kompresi bimanual</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">l.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Versi ekstraksi gemelli pada kelahiran bayi kedua dan seterusnya</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">m.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Vakum ekstraksi dengan kepala bayi di dasar panggul</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">n.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Pengendalian anemia</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">o.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Meningkatkan pemeliharaan dan penggunaan ASI</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">p.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Resusitasi pada bayi baru lahir dengan asfiksia</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">q.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Menangani hipotermia</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;">r.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Pemberian minum dengan sonde/ pipet</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 21.3pt; text-align: left; text-indent: -18pt;"><i><span style="font-style: normal;">s.<span style="font: 7pt "Times New Roman";"> </span></span></i><i><span style="font-style: normal;">Memberikan surat kelahiran</span></i></div><div style="text-align: left;"></div><div style="line-height: 150%; text-align: left;"><br />
<b>2. Pelayanan keluarga berencana</b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 35.45pt; text-align: left; text-indent: -18pt;">a.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Memberikan obat dan alat kontrasepsi oral, suntikan, dan alat kontrasepsi dalam rahim, alat kontrasepsi bawah kulit dan kondom</span></i>.</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 35.45pt; text-align: left; text-indent: -18pt;">b.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Memberikan penyuluhan/ konseling pemakaian kontrasepsi</span></i>.</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 35.45pt; text-align: left; text-indent: -18pt;">c.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Melakukan pencabutan alat kontrsepsi dalam rahim</span></i>.</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 35.45pt; text-align: left; text-indent: -18pt;">d.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Melakukan pencabutan alat kontrsepsi bawah kulit tanpa penyulit</span></i>.</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 14.2pt; text-align: left; text-indent: -18pt;"><span style="font: 7pt "Times New Roman";"></span><i><span style="font-style: normal;">e. Memberikan konseling untuk pelayanan kebidanan, keluarga berencana dan kesehatan masyarakat</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: -3.8pt; text-align: left;"><br />
</div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 14.2pt; text-align: left; text-indent: -18pt;"><b>3.<span style="font: 7pt "Times New Roman";"> </span></b><b>Pelayanan kesehatan masyarakat</b><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 35.45pt; text-align: left; text-indent: -18pt;">a.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Membina peran serta masyarakat di bidang kesehatan ibu dan anak</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 35.45pt; text-align: left; text-indent: -18pt;">b.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Memantau tumbuh kembang anak</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 35.45pt; text-align: left; text-indent: -18pt;">c.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Melaksanakan pelayanan kebidanan komunitas</span></i><b></b></div><div style="text-align: left;"></div><div style="line-height: 150%; margin-left: 35.45pt; text-align: left; text-indent: -18pt;">d.<span style="font: 7pt "Times New Roman";"> </span><i><span style="font-style: normal;">Melaksanakan deteksi dini, melaksanakan pertolongan pertama, merujuk dan memberikan penyuluhan infeksi menular seksual (IMS) penyalahgunaan narkotika, psikotropika, dan zat adiktif (NAPZA) serta penyakit lainnya.</span></i><b></b></div><div style="text-align: left;"></div><div class="MsoNormal" style="text-align: left;"><br />
</div></div>blog bidan aie mawarhttp://www.blogger.com/profile/01675794479695431311noreply@blogger.com0