asma yovi

7/21/2019 asma yovi

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ASMA pada KEHAMILAN

Angka kejadian 3.7-8.4% dari semua

kehamian

!ena"aaksanaan #ang "epa"

menurunkan risik$ "erhadap iu dananak

Kehamian imun$supresi &isi$$gis

!eruahan keadaan imun$$gi saa" hamipada pen#andang asma erpengaruh

"erhadap peningka"an risik$ k$mpikasi

pada iu dan janin

7/21/2019 asma yovi


Asma

!en#empi"an sauran napas

Iu hami ernapas un"uk ' $rang

(ksigenisasi janin erkurangk$mpikasi

)idak "erk$n"r$ risik$ meningka"

7/21/2019 asma yovi


K$mpikasi

!ada *anin

Kecacatan pada janin

Risiko kematian perinatal

meningkatRetardasi pertumbuhan

intrauterin

Prematur

BBLR

Hipoksia neonatal

!ada Iu

Preeklamsia

Hiperemesis gravidarum

Perdarahan pervaginam

Komplikasi kelahiran

lainnya

7/21/2019 asma yovi


KE+A+A)AN !A,A *ANIN

As"hma eaera"i$ns during "he &irs""rimes"er $& pregnan# /ere &$und "$

signi&ian"# inrease "he risk $& a

$ngeni"a ma&$rma"i$n. 0* Aerg# +in

Immun$ '1182'375-84.6

K$mpikasi

7/21/2019 asma yovi


Jana et al. found that the mean birth

eight of neonates born to mothers

ho ere hospitali!ed for asthma

during pregnancy as about "## g

loer than that of neonates born to

asthmatic mothers ho ere not

hospitali!ed $Respiratory %edicine$&#'#( '#") '&*+,'&+*(

7/21/2019 asma yovi


Kontrol optimal gejala respirasi termasuk

serangan malam

-apat mencapai atau mendekati fungsi

paru normal

-apat beraktivitas sehari,hari

%enghindari atau meminimalisir

serangan asma

%enjaga dan menghindari efek samping

obat terhadap ibu dan janin

ujuan penatalaksanaan

7/21/2019 asma yovi


Manajemen asma

. Menggunakan pengukuran $jek"i&un"uk peniaian dan m$ni"$ring iudan janin

'. Menghindari dan meng$n"r$pene"us asma

3. Manajemen renana peng$a"an

dan menga"asi serangan4. Edukasi

. ,ukungan !sik$$gi

7/21/2019 asma yovi


ujuan utama penatalaksanaan asma

selama kehamilan adalah untuk mengontrol

terjadinya serangan asma. Penyandang

asma harus tetap melanjutkan terapikontrol asma yg sudah didapatkan sebelum

kehamilan

Penilaian kontrol asma pada kehamilandirekomendasikan dilakukan setiap bulan

termasuk juga penilaian keadaan janin

melalui /01

7/21/2019 asma yovi


)erapi

!eega 0reieer6

2gonis beta &

2ntikolinergik

Kortikosteroid

1ol. 3antin

!eng$n"r$ 0$n"r$er6

Kortikosteroid

0odium kromolin

4edokromil

eofilin 0R

L2B2

ketotifen

7/21/2019 asma yovi


)9EA)MEN)

A$id $r $n"r$ "riggers

S)E! IN)E9MI))EN)


S)E! ' MIL, !E9SIS)EN)A$id $r $n"r$ "riggers

S)E! 3 M(,E9A)E !E9SIS)EN)


S)E! 4 SE:E9E !E9SIS)EN)

+(N)9(LLE9 dai#media"i$ns5 6nhaled steroid5 7r possibly cromone) oraltheophylline or anti,leukotriene

9ELIE:E9

5 6nhaled 8&,

agonist p.r.n.

+(N)9(LLE9 dai#media"i$ns

5 6nhaled steroid and long,actingbronchodilator

5 9onsider anti,leukotriene

9ELIE:E9

5 6nhaled 8&,

agonist p.r.n.

9ELIE:E9

5 6nhaled 8&,

agonist p.r.n.

9ELIE:E9

5 6nhaled 8&,

agonist p.r.n.

+(N)9(LLE9 dai# mu"ipemedia"i$ns

5 6nhaled steroid5 Long,acting bronchodilator 5 7ral steroid

+(N)9(LLE9 n$neS"ep up

if not controlled

$after check on

inhaler techni:ue

and compliance(

S"ep

d$/n

hen

controlled

5 Patient

education

essential at

every step5 Reduce

therapy if

controlled for

at least

; months5 9ontinue

monitoring

1642 1uidelines '<<+

7/21/2019 asma yovi


;se $& m$s" $mm$n as"hma and

aerg# media"i$ns during

pregnan# /as n$" ass$ia"ed /i"h

inreased perinatal risks. Ma"erna

use $& $ra $r"i$s"er$ids /as

independen"# associated ith the

$urrene $& preeampsia 0* Aerg# +inImmun$557211;#',

=.(

7/21/2019 asma yovi


Serangan #ang menganam

ji/a

9i/a#a" pemakaian en"iasi

mekanik

<eruang kai dira/a" karena asma

#ang era"

)erapi $ra s"er$id jangka ama

:ariasi diurna esar )idak pa"uh

!era/a"an "idak adekua"

7/21/2019 asma yovi


P>422L2K024224 20%2 -6 R/%2H

7/21/2019 asma yovi


0elama proses persalinan obat,obatasma tetap dapat diberikan

Penyandang asma yang mendapat

steroid sistemik selama kehamilandianjurkan untuk mendapat steroid 6?selama dan &" jam setelah persalinan.

Persalinan

7/21/2019 asma yovi


CHART 5. DURING DELIVERY

Well controlled mild, moderate, or severe asthma

(PEFR / FEV1 > 80% baseline, no / minimal

symtoms!•"ontin#e ro#tine inhaled asthma medications to $V

ro#te•

dminister hydrocortisone (100 m& every 8 ho#rs#ntil ostart#m ! i' systemic steroids ere ta)en ithin

* ee)s+

•nal&esiavoid morhine and meeridine"onsider 'entanyl"onsider l#mbal eid#ral ith dil#ted concentrations

o' local anesthetic and narcotics•nesthesia, i' necessaryPreanesthetic atroine and &lycoyrolate-o concentrations o' halo&enated anesthetics

Exacerbation of Asthma

(PEFR / FEV . 80% baseline

symtoms heee, co#&h, breathlessness, or chest

ti&htness!

reat e2acerbation3•

$nhaled beta4 a&onist•$V corticostroids•5ydrocortisone (100 m& every 8 ho#rs #ntil ostart#m

! i' systemic steroids ere ta)en ithin * ee)s•62y&en to maintain 64 sat#ration > 7 %

Contine efforts for !a"ina# $e#i!er%

• 9oti'y anesthesia cons#ltant and aediatrician•nal&esia"onsider 'entanyl"onsider eid#ral anal&esia•nesthetic, i' necessary

Preanesthetic atroine and &lycoyrrolate-o concentrations o' halo&enated anesthetic

"ontin#e assessment

•PEFR /FEV1

•62y&en sat#ration

•

$ntensive 'etal monitorin& (consider contin#o#s electronic 'etalmonitorin& or intermittent a#sc#ltation!•Per'orm va&inal delivery, i' ossible

Resiratory 'ail#re

(PEFR /FEV . 4 % : "64 > ;

mm 5&

<ymtoms = e2treme distress,

con'#sion

• 9oti'y anesthesia cons#ltationt and

aediatrician

•$nitiate mechanical ventilation

•

Per'orm va&inal delivery, i' ossible•Emer&ency cesarean section , i' necessary

ssessment at dmission

•edical 5istory

•Physical e2amination

•E2iratory 'lo meas#rement (PEFR or FEV1!

•62y&en sat#ration ( o2ymeter or arterial blood &as!•"are'#l 'etal monitorin&

7/21/2019 asma yovi


DURING DELIVERY




ro#te•

dminister hydrocortisone (100 m& every 8 ho#rs#ntil ostart#m ! i' systemic steroids ere ta)en ithin

* ee)s+






ti&htness!

reat e2acerbation3•

$nhaled beta4 a&onist•$V corticostroids•5ydrocortisone (100 m& every 8 ho#rs #ntil ostart#m





"ontin#e assessment

•PEFR /FEV1


•


Resiratory 'ail#re

(PEFR /FEV . 4 % : "64 > ;

mm 5&


con'#sion


aediatrician


•


Assessment at A$mission

•&e$ica# Histor%

•'h%sica# examination

•Ex(irator% f#o) measrement *'E+R or

+EV,-

•x%"en satration * ox%meter or arteria#

b#oo$ "as-

•Caref# feta# monitorin"

7/21/2019 asma yovi






ti&htness!

reat e2acerbation3•$nhaled beta4 a&onist•$V corticostroids•5ydrocortisone (100 m& every 8 ho#rs #ntil ostart#m





"ontin#e assessment

•PEFR /FEV1


•


Resiratory 'ail#re

(PEFR /FEV . 4 % : "64 > ;

mm 5&


con'#sion


aediatrician


•



/e## contro##e$ mi#$0 mo$erate0 or se!ere asthma

*'E+R 1 +EV, 2 34 base#ine0 no 1 minima# s%m(toms-

•

Contine rotine inha#e$ asthma me$ications to IV rote•A$minister h%$rocortisone *,44 m" e!er% 3 hors nti#

(ost(artm - if s%stemic steroi$s )ere ta6en )ithin 7 )ee6s.

•Ana#"esia

A!oi$ mor(hine an$ me(eri$ine

Consi$er fentan%#

Consi$er #mba# e(i$ra# )ith $i#te$ concentrations of

#oca# anesthetic an$ narcotics

•Anesthesia0 if necessar%

're8anesthetic atro(ine an$ "#%co(%ro#ate

Lo) concentrations of ha#o"enate$ anesthetics

7/21/2019 asma yovi






ro#te•dminister hydrocortisone (100 m& every 8 ho#rs

#ntil ostart#m ! i' systemic steroids ere ta)en ithin

* ee)s+



"ontin#e assessment

•PEFR /FEV1


•


Resiratory 'ail#re

(PEFR /FEV . 4 % : "64 > ;

mm 5&


con'#sion


aediatrician


•




(PEFR / FEV1 . 80% baseline

symtoms heee, co#&h, breathlessness, or chest ti&htness!

reat e2acerbation3

•$nhaled beta4 a&onist

•$V corticostroids•5ydrocortisone (100 m& every 8 ho#rs #ntil ostart#m ! i' systemic steroids ere

ta)en ithin * ee)s

•62y&en to maintain 64 sat#ration > 7 %


• 9oti'y anesthesia cons#ltant and aediatrician•nal&esia"onsider 'entanyl"onsider eid#ral anal&esia

•nesthetic, i' necessaryPreanesthetic atroine and &lycoyrrolate-o concentrations o' halo&enated anesthetic

7/21/2019 asma yovi








* ee)s+



Exacerbation of AsthmaResiratory 'ail#re

(PEFR /FEV . 4 % : "64 > ;

mm 5&


con'#sion


aediatrician


•



Contine assessment

•'E+R 1+EV,

•x%"en satration

•Intensi!e feta# monitorin" *consi$er continos e#ectronic feta#

monitorin" or intermittent asc#tation-

•'erform !a"ina# $e#i!er%0 if (ossib#e

7/21/2019 asma yovi








* ee)s+






ti&htness!

reat e2acerbation3•$nhaled beta4 a&onist•$V corticostroids•5ydrocortisone (100 m& every 8 ho#rs #ntil ostart#m





"ontin#e assessment

•PEFR /FEV1


•


Res(irator% fai#re

*'E+R 1+EV, 9 :5 ; 'C:

2 <5 mm H"

=%m(toms > extreme $istress0

confsion

ssessment at dmission

•edical 5istory

•Physical e2amination

•E2iratory 'lo meas#rement (PEFR or FEV1!

•62y&en sat#ration ( o2ymeter or arterial blood &as!•"are'#l 'etal monitorin&

•Notif% anesthesia cons#tation an$

(ae$iatrician

•Initiate mechanica# !enti#ation

•'erform !a"ina# $e#i!er%0 if (ossib#e

•Emer"enc% cesarean section 0 if

necessar%

7/21/2019 asma yovi


Health professionals should encourage

pregnant asthmatic omen to continue

their controller therapy to control their

asthma symptoms) avoide@acerbations) and reduce the risk of

congenital malformations

7/21/2019 asma yovi


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H24K A7/

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asma yovi

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