PRECLAMPSIA

Preeclampsia is a multisystem disorder of pregnancy characterized by the presence of hypertension and proteinuria after 20 weeks gestation. While estimated to affect only 3%–5% of all pregnancies in the U.S., the disorder is responsible for 15% of premature deliveries and up to 18% of maternal deaths. In fact, complications from hypertension in pregnancy are the third leading cause of maternal death, surpassed only by embolism and hemorrhage. Other risks associated with preeclampsia include placental abruption, liver or renal failure, disseminated intravascular coagulopathy, cardiovascular complications, and seizures or other neurological manifestations (eclampsia).

The incidence of preterm birth is also higher in preeclamptic women, primarily because obstetricians attempt to minimize the risks to both the mother and fetus by delivering the fetus early. However, preterm infants are at risk of complications as well. They have a greater probability of developing respiratory distress syndrome, intraventricular hemorrhage, cerebral palsy, and other neurological and developmental delays. In women whose preeclampsia is caused by placental anomalies, severe intrauterine fetal growth restriction may occur, leading to higher prevalence of intrauterine asphyxia and placental abruption.

Despite being well recognized as a complication of pregnancy, many unknowns still surround prediction, diagnosis, and pathophysiology of preeclampsia, earning it the common name, “disease of theories.” Efforts to lessen the risks associated with preeclampsia have been focused on accurate and earlier diagnosis of the disorder. New biomarkers for predicting and possibly preventing preeclampsia promise to give the laboratory a major role in the care of at-risk pregnant women. Here we describe the current understanding of the etiology of preeclampsia, the lab’s current role in monitoring at-risk women, as well as how new biomarkers on the horizon may lead to greater involvement of the lab in earlier prediction of the condition.

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PREEKLAMPSIA

Preeklampsia ringan jika didapatkan tekanan darah absolut 140/90 mmHg atau kenaikan sistolik 30 mmHg dan diastolik 15 mmHg, edema ringan dengan kenaikan BB 1 kg/minggu dan proteinuria di atas 0,3 gr/24 jam atau plus 1-2. Sedangkan preeklampsia berat jika didapatkan salah satu dari gejala berikut, tekanan darah 160/110 mmHg, edema umum dan paru disertai sesak dan sianosis, proteinuria di atas 5 gr/24 atau plus 4-5 dan oliguria, air kencing kurang dari 500 cc/24 jam (Manuaba, 2006).

Pada pemeriksaan fisik umum lainnya seperti pemeriksaan retina didapatkan spasme arteriolar dan kilauan retina dapat terlihat, selain itu juga refleks tendon profunda (lutut dan kaki) didapatkan hiperefleksi dan klonus merupakan petunjuk dari peningkatan iritabilitas susunan saraf pusat dan mungkin meramalkan suatu kejang eklampsia (Supriyadi dan Gunawan, 2001).

Pada pemeriksaan abdomen dapat dijumpai rasa sakit daerah hepar merupakan suatu tanda potensial yang tidak menyenangkan dari preeklampsia berat dan dapat meramalkan ruptur dari hepar. Pemeriksaan uterus penting untuk menilai umur kehamilan, adanya kontraksi uterus dan presentasi janin. Selain itu juga pada pemeriksaan pelvis yaitu keadaan serviks dan stasi dari bagian terbawah merupakan pertimbangan yang penting dalam merencanakan kelahiran per vaginam atau per abdominam (Supriyadi dan Gunawan, 2001).