Primigravida Hamil 12 Minggu dengan Atrial Septal Defect Secundum dan Hipertensi Pulmonal Berat Janin Tunggal Hidup Intrauterin

Cindy Kesty, Nuswil Bernolian, Kgs Irawan Satria Arjanggi

Abstract


Latar Belakang: Atrial Septal Defect (ASD) apabila disertai hipertensi pulmonal berat harus dikonseling karena tingginya insiden morbiditas dan mortalitas ibu dan janin.
Tujuan: Memaparkan sebuah kasus primigravida dengan ASD secundum dan hipertensi pulmonal berat sehingga dapat dilakukan tatalaksana dan pemilihan kontrasepsi yang sesuai.
Metode: Laporan kasus seorang wanita berusia 30 tahun, hamil 12 minggu, mengeluh sesak nafas, batuk pada malam hari, dan jantung berdebar-debar. Hasil rontgen thoraks menunjukkan gambaran hipertensi pulmonal disertai peningkatan vaskularisasi paru. Kateterisasi jantung menunjukkan ASD secundum besar, hipertensi pulmonal berat, high flow, high resistance, dan reaktif dengan tes O2. Hasil ekokardiografi (2017) menunjukkan ASD secundum berat, regurgitasi trikuspid dan pulmonal moderat. Ultrasonografi abdomen menunjukkan kesan hamil 12 minggu janin tunggal hidup intrauterin, mioma uteri intramural dan subserosum, perdarahan subamnion dan subkorion. Pada pasien ini, dilakukan abortus provokatus medisinalis melalui pemberian Prostaglandin dilanjutkan dengan dilatasi dan kuretase.
Kesimpulan: Kehamilan pada wanita dengan ASD umumnya ditoleransi dengan baik, dengan luaran ibu dan janin yang baik. Pasien dengan penyakit jantung berat sebaiknya tidak hamil dan bila hamil sebaiknya diterminasi. Preparat estrogen merupakan kontraindikasi pada pasien jantung. Pemilihan kontrasepsi harus mempertimbangkan keparahan, tipe anatomis kelainan jantung, dan keinginan ibu untuk mempertahankan fungsi reproduksinya.

Kata Kunci: primigravida, ASD secundum, hipertensi pulmonal
  Abstract
Background: Atrial Septal Defect (ASD) with severe pulmonary hypertension should be counseled because of the high incidence of maternal and fetal morbidity and mortality.
Objective: Describing a case of primigravida with ASD secundum and severe pulmonary hypertension so that appropriate management and contraception can be selected.
Method: A 30-year-old woman, 12 weeks pregnant, suffered from shortness of breath, coughing at night, and palpitations. Chest X-ray showed pulmonary hypertension with increased pulmonary vascularity. Cardiac catheterization showed a large ASD secundum, severe pulmonary hypertension, high flow, high resistance, and reactive O2 test. Echocardiography (2017) showed severe ASD secundum, moderate tricuspid, and pulmonary regurgitation. Abdominal ultrasonography showed 12 weeks gestational age single live fetus intrauterine, intramural and subserosal uterine myoma, and also subamniotic and subchorionic bleeding. We did provoked abortion using Prostaglandin continued with dilatation and curettage.
Conclusion: Pregnancy in women with ASD is generally well tolerated, with good maternal and fetal outcomes. Patients suffered from severe heart disease should not be pregnant, and if necessary get pregnancy terminated. Estrogen preparations are contraindicated in these patients. The choice of contraception must consider the severity, the anatomy of heart abnormality, and mother's desire to maintain her reproductive function.

Key words: primigravida, ASD secundum, pulmonary hypertension.

Keywords


primigravida; ASD secundum; hipertensi pulmonal

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References


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