Tatalaksana Komprehensif Preeklampsia Berat Dengan Diabetes Melitus Gestasional Pada Kehamilan Aterm Usia Maternal Lanjut : Laporan Kasus

Abstract

Severe preeclampsia (PE) and gestational diabetes mellitus (GDM) are pregnancy complications that contribute significantly to maternal and perinatal morbidity and mortality . Both conditions increase the risk of endothelial dysfunction, uteroplacental insufficiency, fetal growth restriction, and labor complications. Early identification and appropriate management are crucial to prevent adverse outcomes for both mother and fetus. A woman presented with abdominal tenderness, accompanied by severe dizziness, the patient complained of swollen feet and dizziness since 22 weeks of pregnancy. The patient had a history of GDM diagnosed at 11 weeks of gestation (initial FBS 241 mg/dL) and a history of uncontrolled hypertension. Physical examination revealed a blood pressure of 164/108 mmHg and tachycardia (119 beats/minute). Supporting examinations confirmed hyperglycemia (RBG 220 mg/dL), proteinuria 3+ and glucosuria 2+. Ultrasonography (USG) revealed a single, live intrauterine fetus with an estimated fetal weight of 3397 grams. The patient was given initial therapy consisting of lung maturation with dexamethasone, seizure prophylaxis with magnesium sulfate, and nifedipine as an antihypertensive. Management of DMG includes nutritional therapy, and serial blood glucose monitoring. Immediate termination of pregnancy was performed via Caesarean section (CS) integrated with established contraception through the Method of Operating on Women (MOW) due to multiparity and medical risk Postoperative medical monitoring demonstrated good clinical recovery and stable hemodynamics until discharge. This case report aims to evaluate the clinical challenges and management of an elderly multiparous patient with severe preeclampsia and gestational diabetes.