Triple-Threat Pregnancy: Navigating PPCM, Preeclampsia, and Thalassemia Major – A Holistic Reproductive Risk Assessment Post-Cesarean Delivery

Arya Ady Nugroho; Yudianto Budi Saroyo; Dwiana Ocviyanti

doi:10.56951/qdxs3625

Triple-Threat Pregnancy: Navigating PPCM, Preeclampsia, and Thalassemia Major – A Holistic Reproductive Risk Assessment Post-Cesarean Delivery

Penulis

Arya Ady Nugroho Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/National General Hospital of Dr. Cipto Mangunkusumo, Jakarta, Indonesia
Yudianto Budi Saroyo Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/National General Hospital of Dr. Cipto Mangunkusumo, Jakarta, Indonesia
Dwiana Ocviyanti Division of Social Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/National General Hospital of Dr. Cipto Mangunkusumo, Jakarta, Indonesia

DOI:

https://doi.org/10.56951/qdxs3625

Kata Kunci:

kardiomiopati peripartum, preeklampsia, β-talasemia mayor, fraksi ejeksi, kehamilan risiko tinggi, pendekatan holistik

Abstrak

Latar Belakang: Kehamilan yang dipersulit oleh beberapa kondisi maternal berat seperti kardiomiopati peripartum (peripartum cardiomyopathy/PPCM), preeklampsia, dan β-talasemia mayor menimbulkan risiko yang signifikan bagi ibu dan janin. Laporan kasus ini mengeksplorasi tantangan penanganan kehamilan berisiko tinggi yang melibatkan kondisikondisi
tersebut dan menyoroti pentingnya pendekatan multidisiplin dalam manajemen kehamilan risiko tinggi.
Presentasi Kasus: Seorang wanita hamil berusia 33 tahun dengan β-talasemia mayor datang pada usia kehamilan 32⁺⁴ minggu dengan dispnea akut, preeklamsia berat, dan tanda-tanda PPCM. Pasien mengandung janin kembar dikorionik diamniotik dan memerlukan seksio sesarea darurat setelah dilakukan stabilisasi. Ekokardiografi menunjukkan
disfungsi sistolik ventrikel kiri berat dengan fraksi ejeksi 35%. Pasien menjalani penanganan pascaoperasi segera dan menerima pemasangan intrauterine device (IUD) trans-seksio untuk kontrasepsi jangka panjang. Kedua neonatus dirawat di neonatal intensive care unit (NICU) untuk perawatan prematuritas.
Kesimpulan: Kasus ini menekankan kebutuhan mendesak akan pendekatan holistik dan multidisiplin dalam penatalaksanaan kehamilan risiko tinggi yang kompleks, dengan fokus pada stabilisasi maternal segera, perawatan neonatal, dan perencanaan reproduksi jangka panjang.

Unduhan

Baca Selengkapnya

Referensi

1. Bauersachs J, König T, van der Meer P, Petrie MC, Hilfiker-Kleiner C, Mbakwem A, et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail. 2019 Jul;21(7):827–43. doi: 10.1002/ejhf.1493. Epub 2019 Jun 27. PMID: 31243866.

2. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165–241. doi: 10.1093/eurheartj/ehy340.

3. Elkayam U. Clinical characteristics of peripartum cardiomyopathy in the United States: diagnosis, prognosis, and management. J Am Coll Cardiol. 2011;58(7):659–70.

4. American College of Obstetricians and Gynecologists. Gestational Hypertension and Preeclampsia. ACOG Practice Bulletin No. 222. Obstet Gynecol. 2020;135(6):e237–60. doi: 10.1097/AOG.0000000000003891.

5. Magee LA, von Dadelszen P, Stones W, Mathai M. The FIGO textbook of pregnancy hypertension: an evidence-based guide to monitoring, prevention, and management. London: Global Library of Women’s Medicine; 2016.

6. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams Obstetrics. 25th ed. New York: McGraw-Hill; 2022.

7. RCOG. Management of Women with Cardiac Disease in Pregnancy. Green-top Guideline No. 13a. Royal College of Obstetricians and Gynaecologists; 2021.

8. Weatherall DJ, Clegg JB. Inherited haemoglobin disorders: an increasing global health problem. Bull World Health Organ. 2001;79(8):704–12.

9. Cappellini MD, Cohen A, Porter J, Taher A, Viprakasit V. Guidelines for the management of transfusion dependent thalassaemia (TDT). 3rd ed. Thalassaemia International Federation; 2021.

10. World Health Organization. Report of a WHO Technical Consultation on Birth Spacing. Geneva: WHO; 2005.

11. Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ, et al. Outcome of pregnancy in women with heart disease: a review. J Am Coll Cardiol. 2007;49(24):2303–11. doi: 10.1016/j.jacc.2007.03.027.

12. Elkayam U, Goland S, Pieper PG, Silversides CK. High-Risk Cardiac Disease in Pregnancy: Part II. J Am Coll Cardiol. 2016;68(5):502–16. doi: 10.1016/j.jacc.2016.05.050.

13. Bhardwaj, A, Fedson, S, Munagala, M. et al. Pregnancy in Patients With Advanced Heart Failure: impact of Overturn of Roe v Wade Ruling . J Am Coll Cardiol HF. 2023 Mar, 11 (3) 362–364. doi: 10.1016/j. jchf.2022.12.013.

14. American College of Obstetricians and Gynecologists' Presidential Task Force on Pregnancy and Heart Disease and Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 212: Pregnancy and Heart Disease. Obstet Gynecol. 2019 May; 133(5):e320–56. doi: 10.1097/AOG.0000000000003243. PMID: 31022123.

15. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 757: Screening for Perinatal Depression. Obstet Gynecol. 2018;132(5):e208–22. doi: 10.1097/AOG.0000000000002927.