MANAJEMEN HIPOVOLEMIA PADA PASIEN HIPEREMESIS GRAVIDARUM: STUDI KASUS KEBIDANAN DI RS FATIMA PAREPARE
Abstract
Hiperemesis gravidarum (HG) merupakan bentuk berat dari mual dan muntah dalam kehamilan yang berisiko tinggi memicu komplikasi utama berupa hipovolemia, dehidrasi berat, serta ketidakseimbangan elektrolit. Artikel ini bertujuan mengkaji secara mendalam manajemen klinis hipovolemia akibat HG berdasarkan integrasi bukti ilmiah terkini dan studi kasus pada pasien kebidanan di RS Fatima Parepare. Metode yang digunakan adalah studi kasus kualitatif-deskriptif terhadap 2 pasien rawat inap kebidanan dengan diagnosis HG grade II dan dehidrasi sedang-berat. Instrumen penilaian mengombinasikan kriteria diagnosis konsensus Windsor dan Standar Diagnosis Keperawatan Indonesia (SDKI) untuk masalah utama hipovolemia. Hasil studi kasus menunjukkan bahwa kedua pasien mengalami tanda hipovolemia nyata saat masuk: turgor kulit menurun, membran mukosa kering, oliguria, hipotensi, serta hemokonsentrasi. Penatalaksanaan berfokus pada rehidrasi cairan intravena agresif (kristaloid NaCl 0,9% dan Ringer Laktat), koreksi elektrolit, suplementasi tiamin intravena sebelum pembebanan glukosa untuk mencegah ensefalopati Wernicke, serta terapi antiemetik bertahap. Setelah 3–4 hari perawatan terintegrasi, dialami perbaikan perfusi jaringan, pemulihan volume cairan intravaskular, dan normalisasi keseimbangan elektrolit. Kesimpulannya, intervensi awal berbasis resusitasi cairan yang adekuat, suplementasi tiamin, dan pemantauan hemodinamik ketat efektif mengatasi masalah utama hipovolemia pada HG serta mencegah komplikasi maternal dan neonatal yang fatal.
Kata kunci: Hiperemesis gravidarum, hipovolemia, rehidrasi intravena, tiamin, RS Fatima Parepare
ABSTRACT
Hyperemesis gravidarum (HG) represents the most severe continuum of nausea and vomiting in pregnancy, frequently complicated by hypovolemia, severe dehydration, and electrolyte imbalances. This study aims to evaluate the clinical management of hypovolemia secondary to HG by integrating current scientific evidence with a clinical case study conducted in the obstetric ward of Fatima Hospital, Parepare. A descriptive case study methodology was employed involving 2 hospitalized pregnant women diagnosed with Grade II HG and moderate-to-severe dehydration. Assessment tools integrated the Windsor consensus criteria and the Indonesian Nursing Diagnosis Standards (SDKI) focusing on hypovolemia as the primary diagnosis. Clinical findings upon admission revealed overt manifestations of hypovolemia, including decreased skin turgor, dry mucous membranes, oliguria, hypotension, and hemoconcentration. Management focused on aggressive intravenous fluid resuscitation (0.9% NaCl and Ringer's Lactate), electrolyte rebalancing, intravenous thiamine administration prior to glucose infusion to prevent Wernicke's encephalopathy, and stepwise antiemetic regimens. Following 3–4 days of structured multidisciplinary care, both patients demonstrated restoration of intravascular volume, improved tissue perfusion, and normalized electrolyte status. In conclusion, timely fluid resuscitation combined with thiamine supplementation and strict hemodynamic monitoring effectively resolves hypovolemia in HG, mitigating severe maternal and perinatal complications.
Keywords: Hyperemesis gravidarum, hypovolemia, intravenous rehydration, thiamine, Fatima Hospital Parepare
Keywords
Full Text:
PDF (Bahasa Indonesia)References
Vinnars, M.-T., Forslund, M., Claesson, I.-M., Hedman, A., Peira, N., Olofsson, H., Wernersson, E., & Ulfsdottir, H. (2024). Treatments for hyperemesis gravidarum: A systematic review. Acta Obstetricia et Gynecologica Scandinavica, 103(1), 13–29. https://doi.org/10.1111/aogs.14706
Jansen, L. A. W., Shaw, V., Grooten, I. J., Koot, M. H., Dean, C. R., & Painter, R. C. (2024). Diagnosis and treatment of hyperemesis gravidarum. CMAJ, 196(14), E477–E485. https://doi.org/10.1503/cmaj.221502
Jansen, L. A. W., Koot, M. H., Van’t Hooft, J., Dean, C. R., Dijkmans, F., et al. (2021). The Windsor definition for hyperemesis gravidarum: A multistakeholder international consensus definition. European Journal of Obstetrics & Gynecology and Reproductive Biology, 266, 15–22. https://doi.org/10.1016/j.ejogrb.2021.09.004
Royal College of Obstetricians and Gynaecologists. (2024). Updated RCOG Green-top Guideline on the Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69). London: RCOG.
Fejzo, M. S., Sazonova, O. V., Sathirapongsasuti, J. F., Hallgrimsdottir, I. B., Vacic, V., et al. (2024). GDF15 linked to maternal risk of nausea and vomiting during pregnancy. Nature, 625, 760–767. https://doi.org/10.1038/s41586-023-06921-9
Jansen, L. A. W., Nijsten, K., Limpens, J., van Eekelen, R., Koot, M. H., Grooten, I. J., Roseboom, T. J., & Painter, R. C. (2023). Perinatal outcomes of infants born to mothers with hyperemesis gravidarum: A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 284, 30–51. https://doi.org/10.1016/j.ejogrb.2023.03.004
Nijsten, K., Jansen, L. A. W., Limpens, J., Finken, M. J. J., Roseboom, T. J., & Painter, R. C. (2022). Long-term health outcomes of children born to mothers with hyperemesis gravidarum: A systematic review and meta-analysis. American Journal of Obstetrics & Gynecology, 227(5), 677–688.e17. https://doi.org/10.1016/j.ajog.2022.04.018
van der Minnen, L. M., et al. (2025). The impact and management of hyperemesis gravidarum: Current and future perspectives. International Journal of Gynecology & Obstetrics, 168(1), 45–58. https://doi.org/10.1002/ijgo.70165
Tim Pokja SDKI DPP PPNI. (2017). Standar Diagnosis Keperawatan Indonesia: Definisi dan Indikator Diagnostik (Edisi 1). Jakarta: Dewan Pengurus Pusat Persatuan Perawat Nasional Indonesia.
Refbacks
- There are currently no refbacks.