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Jul 07, 2018

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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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