DM & Hipertiroid

20
OBESITAS, DM GESTASIONAL DAN KEHAMILAN

description

obgyn

Transcript of DM & Hipertiroid

  • OBESITAS, DM GESTASIONAL DAN KEHAMILAN

  • OBESITAS DI NEGERI MAJU BUKAN JEPANG

    OVERWEIGHT-BMI 25 29,9OBESITY BMI > 30WANITA > PRIA1/3 ORANG AMERIKA OBESE25 % WANITA AMERIKA OVERWEIGHT, 25 % OBESEMENINGKAT TERUS DALAM 100 TAHUN TERAKHIR-TIDAK BERHASIL DITURUNKAN SEPERTI MMR DI INDONESIAANGKA KEMATIAN PADA OBESE + DM 4 X >+ APPENDICITIS 2 X + KECELAKAAN >

  • Diabetes MellitusMetabolisme karbohidrat dalam kehamilan Insulin ibu tdk dpt mencapai janinTimbul Resistensi InsulinProduksi rendah, Reseptor rusakMengakibatkan Hipoinsulin IbuTimbullah keadaan Hiperglikemi Diabetes dalam KehamilanTimbul Hiperinsulin Janin

  • THE PHYSIOLOGIC FEEDBACK LOOPOBESITY ( LEPTIN RESISTANCE)FOOD INTAKEENERGY EXPENDITUREFAT CELLSPANCREASLEPTININSULIN- HYPOTHALAMUS (NPY AND OTHERS)- SYMPATHETIC NERVOUS SYSTEM

  • PENAPISAN DM GESTASIONALLow RiskBlood glucose testing not routinely required if all of the following characteristics are present :Member of an ethnic group with a low prevalence of gestational diabetesNo known diabetes in first degree relativesAge less than 25 yearsWeight normal before pregnancyNo history of abnormal glucose metabolismNo history of poor obstetrical outcomeAverage RiskPerform blood glucose testing at 24 28 weeks using one of the following :Average risk women of Hispanic, African, Native American, South of East Asian originsHigh risk women with marked obesity, strong family history of type 2 diabetes, prior gestational diabetes, or glucosuriaHigh RiskPerform blood glucose testing as soon as feasible : If gestational diabetes is not diagnosed, blood glucose testing should be repeated at 24 28 weeks or at any time a patient has symptoms or signs suggestive of hyperglycemia

  • SKRININGWANITA RISIKO TINGGI24-28 MINGGU50 G LOADING GLUKOSA PLASMA > 140 G%DILANJUTKAN DENGAN TTGO U/ DIAGNOSIS

  • DIAGNOSIS: TTGO100 G BUKAN 75 GGLUKOSA PLASMA PUASA1 JAM2 JAM3 JAM

  • DIAGNOSIS DM GESTASIONAL

    Timing of MeasurementPlasma Glucose ( mg/dL )aNational Diabetes Data Group ( 1979 )Carpenter and Coustan ( 1982 )Fasting105951 hr1901802 hr1651553 hr145140

  • BATASAN DAN KLASIFIKASI DM GESTASIONAL

    GANGGUAN TOLERANSI GLUKOSA BERBAGAI TINGKAT YANG MUNCUL ATAU DIDIAGNOSIS PERTAMA KALI SAAT KEHAMILAN

    CLASSONSETFASTING PLASMA GLUCOSE2-HOUR POSTPRANDIAL GLUCOSETHERAPYA1GESTATIONAL< 105 mg/Dl< 120 mg/dLDIETA2GESTATIONAL> 105 mg/dL> 120 mg/dLINSULINCLASSAGE OF ONSET(yr)DURATION (yr)VASCULAR DISEASETHERAPYBOVER 20< 10NONEINSULINC10 19 10 19 NONEINSULINDBEFORE 10> 20BENIGN RETINOPATHYINSULINFANYANYNEPHROPATHYaINSULINRANYANYPROLIFERATIVE RETINOPATHYINSULINHANYANYHEARTINSULIN

  • Pengaruh terhadap kehamilanPreeklampsiHidramnionKelainan letak janinAbortusPartus Prematurus

  • Pengaruh terhadap PersalinanInertia uteriDistosia bahuIUFDInfeksi meningkatSC meningkatMMR meningkat

  • Pengaruh terhadap NifasInfeksi nifasSepsisWound Dehiscene

  • Pengaruh terhadap JaninCacat BawaanIUFDDismaturitasMakrosomiaKematian NoenatalRDS

  • PENATALAKSANAAN OBSTETRISBISA SAMPAI ATERM MAKSIMAL 40 MINGGUTIDAK PERLU MENCARI KELAINAN BAWAAN JANINWaspada MAKROSOMIAPERVAGINAM, SC A/I OBSTETRIS

  • KomplikasiMAKROSOMIA DG SEGALA AKIBATNYA:DISTOSIA BAHU O/K VISEROMEGALITRAUMA PERSALINANJAUNDICESC MENINGKATDM nyata pada ibuObesitas dan DM nyata pada bayi

  • MAKROSOMIA

  • Hipertiroid dalam KehamilanMerupakan Hiperfungsi kelenjar Gondok ( Tiroid )Insiden : 0,2 % kehamilanSering mengalami :- Gangguan Haid- Infertilitas

  • Klinis ExopthalmusTremorBerdebar - debarTakikardiMetabolisme basal meningkatHormon Tiroksin meningkat

  • DiagnostikAdanya kelenjar gondokKlinisLaboratoris TSHS, T3 dn FT4

  • PenatalaksanaanMedis- PTU- Lugol- PropanololPersalinan- Pervaginam- SC ai obstetris