28. The massive problem of preeclampsia in indonesia: In need of a redesigned national health care system

Akbar, Muhammad Ilham Aldika; Bachnas, Muhammad Adrianes; Mose, Johannes C.; Dachlan, Erry Gumilar; Ernawati, Ernawati; Dekker, Gustaaf A.; Staff, Annetine; Sulistyowati, Sri; Dewantiningrum, Julian; Jayakusuma, Aan; Wantanai, John; Sitepu, Makmur; Effendi, Jusuf Sulaeman; Kristanto, Herman

doi:10.1016/j.preghy.2018.08.051

Cited by 10 publications

(6 citation statements)

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“…Penyakit jantung merupakan penyebab tidak langsung kematian ibu yang paling sering. [4][5][6] Manajemen ibu hamil dengan penyakit jantung merupakan tantangan khusus untuk dokter anestesi. Manajemen anestesi perlu mempertimbangkan pemilihan teknik dan obatobatan yang bertujuan untuk menurunkan preload dan afterload dan meningkatkan kontraktilitas jantung dengan target hemodinamik mencakup laju nadi dipertahankan normal hingga rendah untuk menurunkan kebutuhan oksigen dan pencegahan swing tekanan darah yang besar.…”

Section: Pendahuluanunclassified

Manajemen Anestesi pada Pasien Seksio Sesarea dengan Preeklamsia, Sindrom HELLP, dan Gagal Jantung

Maharani

Bisri

2022

JAOI

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Angka Kematian Ibu (AKI) di Indonesia tinggi dengan hipertensi pada kehamilan dan penyakit jantung sebagai salah satu penyebab utama. Sebagian besar pasien dengan preeklamsia dan gagal jantung menjalani operasi seksio sesarea dan memerlukan manajemen anestesi dengan mempertimbangkan luaran maternal dan janin. Wanita berusia 30 tahun dengan G2P1A0 gravida 32–33 minggu dengan hipertensi kronis diperberat preeklamsia induced Acute Decompensated Heart Failure (ADHF), sindrom Hemolysis Elevated Liver Enzyme Low Platelet (HELLP) dan gagal jantung kelas II-III dengan status fisik ASA IIIE. Dilakukan manajemen anestesi regional epidural dengan tujuan utama mempertahankan hemodinamik ibu. Hemodinamika selama durante operasi stabil. Dilahirkan bayi laki-laki hidup dengan APGAR 6–8. Pasien ditransfer ke High Care Unit (HCU) pascaoperasi. Manajemen anestesi perioperatif pada pasien harus menghindari perubahan hemodinamik yang ekstrem, menjaga aliran darah uteroplasental dan luaran bayi, dan menghindari risiko sulit intubasi dan aspirasi pada ibu hamil. Pada pasien ini dipilih manajemen anestesi epidural dengan monitoring hemodinamik ketat selama durante operasi. Pada pascaoperasi, pasien dirawat di ruang High Care Unit dan diberikan analgetik multimodal untuk menghindari lonjakan hemodinamik akibat nyeri. Pasien pulang ke rumah pada hari ke-5 pascaoperasi. Anestesi regional epidural merupakan pilihan yang dapat digunakan pada pasien preeklamsia berat dengan ADHF dan sindrom HELLP dengan mempertimbangkan keuntungan terhadap luaran maternal dan fetal

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Section: Pendahuluanunclassified

Manajemen Anestesi pada Pasien Seksio Sesarea dengan Preeklamsia, Sindrom HELLP, dan Gagal Jantung

Maharani

Bisri

2022

JAOI

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“…Further research is desired to investigate the pathways acceptability in practice and to confirm the suitability of aspirin prescription for anemic women. Towards the end of the study, new evidence emerged to indicate that anaemia in pregnancy might also be a risk factor for preeclampsia in LMICs [54,55]. This possible risk factor is directly relevant to situations in Indonesia where anemia prevalence is high due to malnutrition, genetics, or infections, such as malaria and hookworm, which cause inflammation in the placenta [54][55][56][57].…”

Section: Suggestion For Further Researchmentioning

confidence: 99%

“…Towards the end of the study, new evidence emerged to indicate that anaemia in pregnancy might also be a risk factor for preeclampsia in LMICs [54,55]. This possible risk factor is directly relevant to situations in Indonesia where anemia prevalence is high due to malnutrition, genetics, or infections, such as malaria and hookworm, which cause inflammation in the placenta [54][55][56][57]. The use of aspirin in anaemic women, however, is not currently supported in any of the existing international HDP guidelines [17] or tested in the survey.…”

Section: Suggestion For Further Researchmentioning

confidence: 99%

Hypertensive disorders of pregnancy (HDP) management pathways: results of a Delphi survey to contextualise international recommendations for Indonesian primary care settings

Ekawati

Licqurish

Gunn

et al. 2021

BMC Pregnancy Childbirth

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Background Hypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care. Methods Maternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. The third-round survey presented the drafts of HDP pathways and sought participants’ agreement and further suggestions. The participants’ agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The participants’ responses and suggestions to the free text questions were analysed thematically. Results A total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. Agreement scores for the statements ranged from 70.8–100.0%, and potential implementation barriers of the pathways were identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. Conclusions Most evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice.

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“…(1) Upaya penurunan AKI termasuk akibat preeklamsi/eklamsi sudah lama menjadi menjadi program unggulan dari pelbagai institusi dunia (WHO, UNICEF, UNFPA) maupun pelbagai pemerintahan Negara maju maupun berkembang. (2,3,4,5,6,7,8) Evaluasi kematian ibu terutama akibat preeklamsi dan eklamsi di Indonesia oleh Himpunan Kedokteran Fetomaternal (HKFM) (9) maupun di RS Hasan Sadikin (RSHS) Bandung (10) juga digunakan untuk menjadi dasar pertimbangan usulan strategi penurunan kematian ibu akibat preeklamsi ini.…”

Section: Pendahuluanunclassified

Strategi Menurunkan Kematian Ibu Karena Preeklamsi dan Eklamsi

Mose¹

2020

Obgynia

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Menyimpulkan beberapa hasil penelitian tentang preeklamsi dan upaya menurunkan kematian ibu di negara maju maupun berkembang termasuk di Indonesia dan RSHS Bandung untuk menyusun strategi menurunkan kematian ibu karena preeklamsi. Metode: Dilakukan penelitian potong silang dengan rancangan observasional analitik dengan membandingkan data ibu hamil dengan preeklamsi/eklamsi yang melahirkan di RS Hasan sadikin Bandung periode Maret sampai September 2012 (sebelum JKN) dan 1 Januari 2016 sampai 31 Desember 2017(saat JKN dilaksanakan). Data dianalisis menggunakan uji statistik chi kuadrat untuk membandingkan perbedaan dengan kemaknaan nilai p< 0,05. Hasil: Terjadi kenaikan prevalensi preeklamsi dari 15,53% sebelum JKN, menjadi 25,04% saat JKN dilaksanakan. Terjadi peningkatan prevalensi preeklmasi menurut usia ibu, usia kehamilan, paritas, tingkat pendidikan, jumlah ANC, dan penyakit penyerta hipertensi dan kelainan jantung sebelum dan saat JKN dilaksanakan. Diskusi : Strategi menurunkan kematian ibu karena preeklamsi/eklamsi, adalah : mendukung program pemerintah untuk mengatasi kemiskinan, pendidikan dan kesulitan transportasi; melaksanakan program sosialisasi kepada masyarakat tentang tanda dan gejala preeklamsi; deteksi dini kelompok risiko dan diagnosis PE dengan pengukuran tekanan darah dan proteinuria serta pemberian pencegahan dengan aspirin dosis rendah dan kalsium; pelatihan pemeriksaan Doppler arteri uterina untuk SpOG serta sosialisasi protokol pengelolaan PE, dan pelatihan 'preeclampsia special team' di RS rujukan. Kata kunci : preeklamsi, kematian ibu, strategi menurunkan kematian ibu.

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28. The massive problem of preeclampsia in indonesia: In need of a redesigned national health care system

Cited by 10 publications

References 0 publications

Manajemen Anestesi pada Pasien Seksio Sesarea dengan Preeklamsia, Sindrom HELLP, dan Gagal Jantung

Manajemen Anestesi pada Pasien Seksio Sesarea dengan Preeklamsia, Sindrom HELLP, dan Gagal Jantung

Hypertensive disorders of pregnancy (HDP) management pathways: results of a Delphi survey to contextualise international recommendations for Indonesian primary care settings

Strategi Menurunkan Kematian Ibu Karena Preeklamsi dan Eklamsi

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