Manajemen Anestesi pada Pasien Seksio Sesarea Primigravida 35 Minggu dengan Sindroma Nefrotik

Abstract

Sindroma nefrotik adalah sekumpulan gejala berupa proteinuria, hipoalbuminemia, edema, hiperkolesterolemia, dan lipiduria yang ditandai peningkatan permeabilitas dinding kapiler terhadap protein serum. Sindroma nefrotik pada kehamilan jarang terjadi namun bila tidak dikelola dengan baik akan meningkatkan morbiditas. Sindroma anefrotik dapat muncul sebelum umur kehamilan 20 minggu dan sering disebabkan oleh glomerulonephritis, sedangkan yang muncul sesudah umur kehamilan 20 minggu patut diduga disebabkan atau disertai suatu preeklampsia. Dilaporkan pasien 35 minggu dengan diagnosis preeklamsia, sindroma nefrotik dan suspek edema pulmo. Pasien di diagnosis sindroma nefrotik sejak kehamilan 12 minggu dan mendapat terapi metilprednisolone 16 mg 1-0-0 hingga sekarang. Pada usia kehamilan 28 minggu pasien didiagnosis preeklamsia. Datang karena kontraksi yang semakin kencang. Pasien dilakukan seksio sesarea dengan tehnik regional anestesi epidural Levobupivacain 0.5% isobarik 11 ml, janin cukup viable dilahirkan. Pasca operasi pasien dirawat di high care unit dan pulang ke rumah setelah perawatan 8 hari dalam kondisi baik. Manajemen anestesia pada ibu hamil dengan sindroma nefrotik antara lain sering disertai tekanan darah tinggi atau preeklampsia, malnutrisi dan hilangnya zat-zat yang diperlukan tubuh bersamaan dengan hilangnya protein melalui urine. Pasien seharusnya ditangani melalui pendekatan multidisipliner dengan spesialis perinatologi, nefrologi, dan neonatologi, dengan pemahaman terhadap pentingnya menjaga keseimbangan agar sesuai dengan perubahan fisiologis wanita hamil normal akan memberikan prognosis yang baik dalam menurunkan tingkat morbiditas.
 Anesthesia Management of Caesarean Section in 35 Weeks Primigravida Patients with Nephrotic Syndrome
 Abstract
 Nephrotic syndrome is a set of symptoms in the form of proteinuria, hypoalbuminemia, edema, hypercholesterolemia, and lipiduria which are characterized by an increase in capillary wall permeability to serum proteins. Nephrotic syndrome in pregnancy is rare but if not managed properly, it will increase a morbidity. Nephrotic syndrome can occur before 20 weeks of gestation and is often caused by glomerulonephritis, whereas if appears after 20 weeks' gestation is thought to be due to or accompanied by preeclampsia. A 35-week patient was reported with preeclampsia, nephrotic syndrome and suspected pulmonary edema. Patients were diagnosed with nephrotic syndrome since 12 weeks' gestation and were treated with methylprednisolone 16 mg 1-0-0 until now. At 28 weeks' gestation the patient was diagnosed with preeclampsia. she came to hospital due to primature contraction. Patient underwent SC with a 11 ml Levobupivacaine 0.5% drug isobaric epidural anesthesia regional technique, the fetus was viable enough to be born. After surgery the patient was treated at HCU and returned home after 8 days of treatment in good condition. Management of anesthesia in pregnant women with nephrotic syndrome is often accompanied by high blood pressure or preeclampsia, malnutrition and loss of substances needed by the body along with loss of protein through urine. Patients should be treated through a multidisciplinary approach, along with specialists in perinatology, nephrology, and neonatology. With an understanding of the importance of maintaining balance in accordance with the physiological changes of normal pregnant women will provide a good prognosis in reducing morbidity.