Suspek Intrahepatic Cholestasis of Pregnancy Tanpa Pemeriksaan Bile Acid: Tantangan Diagnosis di Fasilitas Terbatas dan Luaran Janin
DOI:
https://doi.org/10.59784/glosains.v7i1.664Keywords:
Intrahepatic cholestasis of pregnancy, pruritus, enzim hati, gawat janin, kardiotokografi, luaran perinatalAbstract
Latar belakang: Kolestasis intrahepatik kehamilan (intrahepatic cholestasis of pregnancy, ICP) merupakan gangguan hati spesifik kehamilan yang ditandai dengan pruritus tanpa lesi kulit primer serta peningkatan kadar asam empedu dan enzim hati. Meskipun sering bersifat reversibel setelah persalinan, ICP memiliki implikasi serius terhadap luaran perinatal, termasuk persalinan prematur, gawat janin, dan kematian intrauterin. Pada kasus ini, pemeriksaan asam empedu serum yang merupakan baku emas diagnosis ICP tidak tersedia di fasilitas pelaporan, sehingga diagnosis ditegakkan berdasarkan kriteria klinis-biokimia.
Tujuan: Penelitian kasus ini bertujuan menggambarkan presentasi klinis, temuan laboratorium, perjalanan penyakit, serta pendekatan tatalaksana pada seorang primigravida usia 28 tahun dengan usia kehamilan 33+1 minggu yang didiagnosis ICP di RS Jih Solo.
Metode: Penelitian ini menggunakan desain studi kasus deskriptif kualitatif dengan pendekatan klinis observasional. Rekam medis digunakan sebagai sumber data primer, dan analisis dilakukan secara deskriptif-naratif dengan perbandingan terhadap literatur ICP terkini.
Hasil: Pasien trimester ketiga mengalami pruritus progresif tanpa ruam disertai perubahan warna urin dan feses. Laboratorium menunjukkan peningkatan AST, ALT, dan hiperbilirubinemia ringan dengan skrining hepatitis negatif. Meskipun kondisi maternal stabil, CTG menunjukkan tanda gawat janin. Pemantauan janin intensif dan evaluasi laboratorium serial dilakukan dengan perbaikan fungsi hati bertahap. Kasus ini menekankan pentingnya deteksi dini ICP dan keputusan obstetri tepat waktu untuk mencegah luaran perinatal merugikan.
Kesimpulan: ICP dapat didiagnosis secara klinis dan ditangani secara efektif di fasilitas dengan sumber daya terbatas melalui kewaspadaan klinis, pemantauan biokimia serial, dan pengawasan janin intensif. Temuan ini memberikan kontribusi berupa model diagnostik praktis bagi tatalaksana ICP di fasilitas rujukan dengan keterbatasan sarana laboratorium.
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