A. Background
Preeclampsia and eclampsia is a complication of hypertension in pregnant women. And preeclampsia can be further divided into mild and severe preeclampsia. In Indonesia, after bleeding and infection preeclampsia remains a major cause of maternal and perinatal cause of death is high. Therefore, early diagnosis of preeclampsia eclampsia which is the introductory level, as well as the treatment needs to be done to reduce maternal and child mortality.Malnutrition is still a big problem for the third world, including Indonesia. Nutrition became a serious problem because it would have an impact on the nation's weakening competitiveness due to high morbidity and mortality, as well as intelligence and cognitive impaired children. Groups who are most vulnerable to malnutrition are pregnant women, infants, and toddlers. The tendency of the high number of protein-energy malnutrition in pregnant women increases the risk of maternal morbidity and mortality as well as the mothers who gave birth to babies with low birth weight. Babies born weighing 2500 grams vulnerable to impaired growth and intelligence. Children who are malnourished at birth or during the baby's risk for heart and blood vessel disease, and diabetes mellitus in adulthood. The risk of death from malnutrition is also greater, precisely in the productive age. In pregnancy, besides psychological changes, as well as physiology.
Therefore, early diagnosis of pre-eclampsia and prevent progression to eclampsia should not be the goal of treatment. Estimated pre-eclampsia occurs 5% of pregnancies, is more common in first pregnancies. Also in women who previously suffered from high blood pressure or blood vessel disease.
THEORY REVIEW
A. Definition
Pre-eclampsia is a disease with signs of hypertension, edema, and proteinuria caused by pregnancy (Prof. Dr. Hanifa wiknjosastro, DSOG, et al, 1999:282)
Ekslampsia an acute illness with convulsions and coma in pregnant women and women during childbirth is accompanied by hypertension, edema, and proteinuria (Pusdiknakes, MOH, 1990; 9).
Pre-eclampsia is a complication of pregnancy and ekslampsia the third tri-mester with clinical symptoms of hypertension, edema, protein Uriah, convulsions and coma. (Manuaba, Prof.dr.Ida Gde.Penuntun Registrar Good Clinical Obstetrics And Ginekologi.1993.EGC.Jakarta ).
B. Etiology
The cause of preeclampsia and eclampsia are definitely not in the know.
The theory stout at present as the cause was was placental ischemia or lack of O2 to the placental circulation.
predisposing factors or the occurrence of preeclampsia and eclampsia, among others:
- Diabetes mellitus
- Chronic renal impairment
- Hypertension
- Molahydatidosa
- Polyhydramnion
- Primi old grapida
C. Pathophysiology
Mild preeclampsia rarely cause death. No changes characteristic of preeclampsia and eclampsia. Bleeding, infak, and thrombosis of small blood vessels in this disease can be found in various organs. The changes are most likely caused by vasospasmus arterioles. Accumulation of fibrin in blood vessels is also an important factor in the pathogenesis of these disorders.
Fundamental changes in preeclampsia is obtained spasmus blood vessels accompanied by salt and water retention. In some cases lumenarteriol so small, so it can only be traversed by a single red blood cells only. Raised blood pressure is the pressure of coping with rising peripheral, to be adequate tissue oxygenation. Weight gain and edema due to accumulation of excess fluid in the interstitial space is not known why. In preeclampsia found that low levels of aldosterone and prolactin concentrations were higher than in normal pregnancy. Aldosterone is important to maintain plasma volume and regulate water and sodium retention. In preeclampsia permeabelitas blood vessels to increase protein.
Decreased blood flow to impact the body's organs. In the placenta, resulting in decreased blood flow impaired placental function. In a rather long hypertension, impaired fetal growth. In hypertensive shorter fetal distress can occur until his death from lack of oxygenation.
Lack of blood to the kidneys resulting in reduced glomerular filtration. Abnormalities is important in relation to proteinuria and the retention of salt and water. Glomerular filtration rate decreased to 50% of normal, causing diuresis down, on the state of information can happen olliguri or anuria.
In preeclampsia appear retinal edema, local or generalized spasmus in one or more arteries. Diplopia and amblyopia in cases of preeclampsia symptoms that indicate the occurrence of eclampsia. It is caused by changes in blood flow in the cerebral cortex of vision centers.
Pulmonary edema is a major cause of death of patients pre-eclampsia and eclampsia. These complications are usually caused by the left cardiac decompensation.
High hemoconcentration in preeclampsia and eclampsia is not known why. A shift of water from the intravascular to the interstitial space. An increase hemotokrit, increased serum protein, and increased edema causes decreased blood volume, increased blood viscosity, and time will be more lam circulation direction. Blood flow to different parts of the body is reduced resulting in hypoxia.
