Transcript
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dr Hayu Lestari Haryono SpOG
DIVISI FETO MATERNAL FK USU /RS HAM
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Antiphospholipid Syndrome(APS) AS is !"ara!teri#ed $y
Re!urrent %enous or arteria& t"ro'$osis
Re!urrent (eta& &oss T"ro'$o!ytopenia
resen!e o( anti$odies to p"osp"o&ipid
su!" as anti!ardio&ipin anti$ody )a*L+
and &upus anti!oa,u&ant )LA+
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Pathophysiology of APS in Pregnancy
(1) Activated throphoblastic cells(2) The role of Annexin-V in pregnancy
(3) The role of cytoines
(!) The role endothelial cells and adhesion "olec#les
($) The role of eicosanoid "etabolis"s
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Antiphospholipid antibodies red#ce the tiss#e (throphoblast)
anticog#lant (annexin-V) leading to the for"ation of thro"bosis
A#g"ented release of adhesion "eloc#les at intact endothelial cells
responsible to thro"bosis for"ation %itho#t any vessels inry
'irect effect of thro"bosis pl#g red#cing vessel blood flo% incl#ding
oxygen and "acro-"icron#trient for the conception
ncreased release of cytoines and P*s ind#ce vessel
vasoconstriction leading to higher blood vessel resistance
at"o,enesis o( AS
AS &eadin, (a!tors a((e!tin,t"e !on!eption sur%i%a&s
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Antiphospholipid Syndro"e in Pregnancy
re,nan!y 1asta,ere,nan!y 1asta,eFailure of embryo implantationFailure of embryo implantation
(Reccurrent) miscarriage(Reccurrent) miscarriageIntrauterine growth retardationIntrauterine growth retardationPreeclampsia – Hellp SyndromePreeclampsia – Hellp Syndrome
Intrauterine hypoxiaIntrauterine hypoxiaIntrauterine fetal death – Still birthIntrauterine fetal death – Still birth
Preterm labour – PrematurityPreterm labour – Prematurity
sphyxia neonatorumsphyxia neonatorum
!atasthropic PS puerpurium!atasthropic PS puerpurium"aternal – Perinatal mortality"aternal – Perinatal mortality
Higher caesarean#section rateHigher caesarean#section rate
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at"o,enesis o( AS
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T"ro'$osis (or'ation in AS!o'p&i!ated pre,nan!y
T"ro'$osis o!!urs as an i''uno&o,i!a& )anti,en8anti$ody+ rea!tion o( 3
Presenting ofantiphospholipid antibodies
+e"brane cell of anionic
phospholipid receptors
Phospholipid binding proteinof ,2-glycoprotein- (,2P)
J Witjaksono – PIT XIV Bandung 2004
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Antiphospholipid Syndrome,
Thrombosis & Fetal welfare
J Witjaksono, 2002
Increase ratio tbx/pgi Vaso!onstri!tion
In!rease %as!u&ar resistan!e
Tro!bus deposit De!rease $&ood (&o1
"ecrease ox#gen supp$# Feta& "ypo9ia: !on,enita& ano'a&ies
"ecrease !icro % !acro nutrients Feta& 'a&nutrition: !on,enita& ano'a&ies
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APS – Diagnosis 1
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APS – Diagnosis 2
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PS $% I%F&R'II'S
; Terit radan,pan,,u&: proses IVF8ET sendiri: endo'etriosis d&&
; =u>ti yan, 'endu>un, 3 pe'eri>saan aAter"adap isotip I,G: I,M: I,A untu> ? aA
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KLASIFIKASI SAF
Tipe Mani(estasi
I Tro'$osis %ena da&a' den,an atau
tanpa e'$o&i paru
II Tro'$osis a@!oronaria: a@peri(er:
aorta dan a@!arotis
III Tro'$osis a@retina: %@retina:
sere$ro%as>u&ar: TIA
IV Tro'$osis a@p&asenta: >e'atian &inis
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$I%,SIS
A@ KRITERIA KLINIK
Tro'$osis Vas>u&er
Dite'u>an satu atau &e$i" seran,an tro'$osisarteria&: %ena atau pe'$u&u" dara" >e!i&
Ke!ua&i untu> tro'$osis %ena: dia,nosis "arus
di>on(ir'asi den,an pe'eri>saan Dop&er
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=@ +RI'&RI *,R',RI-"
)T"e Internationa& So!iety on T"ro'$osis and
He'ostatis+
e'eri>saan A*A
Dite'u>an A*A isotip I,G dan atau I,M den,an>adar sedan, atau tin,,i pada B- pe'eri>saanden,an inter%a& 1a>tu C 'in,,u
e'eri>saan LADite'u>an LA pada B pe'eri>saan den,aninter%a& 1a>tu BC 'in,,u
$I%,SIS *,R',RI-"
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$I%,SIS *,R',RI-"
Fos(atidi&serin: (os(atidi&inosito&:
(os(atidi&etano&a'in dan &ipid8&ipid &ain Dia,nosis SAF dite,a>>an atas dasar
pe'eri>saan A*A dan LA
Isotip I,G &e$i" spesi(i> dari I,MGL: ML unit: di'ana >adar renda" $i&a -:>adar sedan, -8? dan >adar tin,,i B?
Usi &ain: pen,aru"o$at8o$atan: de(isiensi (a>tor pe'$e>uan"erediter d&&
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P&%'+S%%
Konse&in, ra>onsepsi
Medi>a'entosa
P&%,*'% "&$I+"&%',S
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P&%,*'% "&$I+"&%',S
re%enti( dan >urati( den,an pe'$erian
anti>oa,u&an dan antia,re,asi tro'$ositHeparin: aspirin dosis renda": ,&u>o>orti>oid atauIVIG@ Ke$er"asi&an 0.
=ir>en(ir&d d>> aspirin dosis renda" )?5',+ danprednison 5', di'u&ai - 'in,,u se$e&u' a1a&si>&us@ Ke$er"asi&an 7C.
S"er d>> "eparin dan aspirin se!ara se&e>ti(dan IVIG se$esar 0',/>,== se&a'a 0 "arisetiap $u&an@ Ke$er"asi&an C-8.
R . d i b t d PS
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Re.omendasi pengobatan pada PS
+ara.teristi. pasien Re.omendasi
Kadar I,G/I,M sedan, tin,,i
ri'ipara Aspirin ora& ?5',/"ari teruta'a
$i&a tro'$osit 0@/'L
Mu&tipara: den,an >riteria Aspirin ora& ?5',/"ari teruta'a
se&uru" >e"a'i&an nor'a& $i&a tro'$osit 0@/'L
Mu&tipara: den,an satu Aspirin
Ke,a,a&an persa&inan pada
Usia ,estasi 50 'in,,u
Mu&tipara: B5 >e,a,a&an Aspirin se 'asa pra>onsepsi
>e"a'i&an tera>"ir pada dan dita'$a">an insi "eparin
usia ,estasi 50 'in,,u 590U/"ari atau LMH :6 2
tanpa penye$a$ e"a'i&an@
+adar Ig/Ig" rendah
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+adar Ig/Ig" rendah
ri'ipara Tida> di$eri>an terapi
Mu&tipara: den,an >riteria Tida> di$eri>an terapi
tanpa ri1ayat KDK
Mu&tipara: den,an >riteria Aspirin dosis renda"
satu >e,a,a&an >e"a'i&an
tera>"ir pada usia ,estasi
50 'in,,u
Mu&tipara: den,an >riteria Aspirin se 'asa
satu >e,a,a&an >e"a'i&an pra>onsepsi dita'$a" insi
tera>"ir pada usia ,estasi "eparin - 9 0 U / "ari atau
50 'in,,u: tanpa LMH :68:C 'L / "ari se&a'a
penye$a$ yan, e"a'i&an
Mu&tipara: ri1ayat E=: T: Aspirin 'u&ai tri'ester perta'a
"ipertensi: peny@,in
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P&%,*'% I%
=ertu 'enin,>at>an e(e> terapeti>anti>oa,u&an dan antia,re,asi
*ipro(&o>sasin $er>"asiat anti>oa,u&an 'e&a&uipenurunan >onsentrasi β-8G5: penurunan aTTdan 'enin,>at>an ar$onat -',/"ari serta Vit D@
Asa' Fo&at 085',/"ari 'en!e,a" de(e>tu$u&us neura& pada
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