Pengaruh Diabetes Mellitus Gestasional Terhadap Sirkulasi Uteroplasenta

Redhy Sindharta -  Bagian Anestesiologi dan Terapi Intensif Fakultas Kedokteran, Universitas Brawijaya/ RSUD dr. Saiful Anwar Malang, Indonesia
*Isngadi Isngadi -  Bagian Anestesiologi dan Terapi Intensif Fakultas Kedokteran, Universitas Brawijaya/ RSUD dr. Saiful Anwar Malang, Indonesia
Yusmein Uyun -  Bagian Anestesiologi dan terapi Intensif, Fakultas Kedokteran, Univeristas Gadjah Mada/ RSUP dr. Sardjito, Yogyakarta, Indonesia
Sri Rahardjo -  Bagian Anestesiologi dan terapi Intensif, Fakultas Kedokteran, Univeristas Gadjah Mada/ RSUP dr. Sardjito, Yogyakarta, Indonesia
Received: 17 Jan 2018; Published: 17 Jan 2018.
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Section: Tinjauan Pustaka
Language: ID
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Abstract
Diabetes mellitus pada kehamilan (Gestational diabetes mellitus/GDM) adalah intoleransi glukosa yang ditemukan pertama kali pada masa kehamilan dan sering menimbulkan komplikasi pada ibu yang mengandung maupun janin yang dikandung. Beberapa organ pada GDM mengalami perubahan struktur dan perubahan fungsi termasuk disfungsi endothel mikrosirkulasi dan makrosirkulasi fetoplasenta. 

Endothelium-derived Relaxing Factors (EDRF) khususnya prostasiklin dan nitrik oksid berperan penting dalam mengontrol sirkulasi fetoplasental. Endothel vaskuler pasien GDM mengalami disfungsi, sehingga sintesa dan pelepasan prostasiklin dan nitrik oksid (NO) mengalami gangguan sehingga tonus arteria meningkat. Peningkatan tonus arteri yang menuju uterus akan menurunkan aliran darah uteroplasenta dan akhirnya menurunkan umbilical blood flow (UmBF). Endothel pembuluh darah merupakan target utama dari stress oksidatif. Sintesa NO merupakan mekanisme penting yang mendasari perubahan pembuluh darah sistemik dan pembuluh darah uterine selama kehamilan.
Beberapa evidensi penelitian membuktikan peranan NO dan ADMA pada kehamilan normal dan insufiensi plasenta. Dengan berkembangnya pengetahuan akan mekanisme gangguan jalur ADMA-NO, pilihan tambahan untuk intervensi terapetik akan dapat ditemukan. Tatalaksana GDM secara umum adalah dengan pengaturan diet, latihan fisik selama tidak ada kontraindikasi, pengawasan dan kontrol gula darah, dan terapi farmakologi Berbagai penelitian lain terus berusaha menemukan terapi-terapi baru untuk memperbaiki endothel dan sirkulasi uteroplasenta pada pasien GDM.

Keywords
diabetes mellitus; gestasional; endothel; sirkulasi uteroplasenta

Article Metrics:

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