Case KPD Prematur-Febrina

8/18/2019 Case KPD Prematur-Febrina

1/20

LAPORAN KASUS

G1P0A0 gravida 24-25 minggu inpartu dengan KPD Preterm

Pembimbing :

dr. Freddy Dinata, Sp.OG

Disusun oleh :

Febrina Hertanti Bakri (40!"!0#$

KEPANITERAAN KLINIK BAGIAN ILMU KEBIDANAN DAN KANDUNGAN

FAKULTAS KEDOKTERAN UNIVERSITAS TARUMANAGARA

RUMA SAKIT UMUM DAERA !IA"I# BOGOR

PERIODE KEPANITERAAN $% &ANUARI ' () MARET (*$)

L%&BAR P%NG%SAHAN


2/20

LAPORAN KASUS

Seo+,ng -,sien .,ni/, ($ /,hun G$P*A* g+,0i1, (23(4 minggu

1eng,n KPD P+e/e+m

Pembimbing

1+5 F+e116 Din,/,# S-5OG

Pel,-o+

Feb+in, e+/,n/i B,7+i

82*)$)$*)9


3/20

'. 'dentita Paien

• N,m, : N65 D

• Umu+ : ($ /hn

•

Pe7e+;,,n : Ibu Rum,h T,ngg,• Pen1i1i7,n : SMA

• Su7u : Be/,.i

• Ag,m, : Isl,m

• Al,m,/ : K-5 Tengge7 RT


4/20

Ri+ayat Penyakit Da-))

• Ri.,6,/ -en6,7i/ /e7,n,n 1,+,h /inggi : 83

• Ri.,6,/ -en6,7i/ 7en?ing m,nis : 83

• Ri.,6,/ -en6,7i/ ,sm, : 83

• Ri.,6,/ -en6,7i/ ,le+gi /e+h,1,- m,7,n,n : 83

• Ri.,6,/ -en6,7i/ ,le+gi /e+h,1,- ob,/ : 83

Ri+ayat Penyakit Ke)ar/a

Ri.,6,/ -en6,7i/ /e7,n,n 1,+,h /inggi# 7en?ing m,nis# ,sm,# 1,n ,le+gi ob,/ 1,n m,7,n,n

1is,ng7,l5

Ri+ayat &entr)ai

• Men,+?he : $( /,hun

• Si7lus mens/+u,si : @ (% h,+i

• L,m, mens/+u,si : = h,+i

• &uml,h -emb,lu/ -e+ h,+i : ( 3 -emb,lu/ < h,+i

• N6e+i s,,/ mens/+u,si : 83

Ri+ayat Pernika-an Pe+ni7,h,n -e+/,m,# meni7,h -,1, usi, (* /,hun5

Ri+ayat Ke-a*ian S,,/ ini h,mil ,n,7 7e3$5 Ri.,6,/ 7egugu+,n 83

Ha*i ke Keadaan

ke-a*ian

ara a-ir U*)r ekaran/ Keadaan anak -id)p1*ati

I ,mil ini

Ri+ayat K2ntraepi Belum -e+n,h mem,7,i ,l,/ 7on/+,se-si

Ri+ayat Operai P,sien belum -e+n,h men;,l,ni o-e+,si sebelumn6,

Ri+ayat Antenata are

Kon/+ol 7eh,mil,n 7e bi1,n5 Ri.,6,/ USG 8 $> 1i -oli7lini7 RSUD !i,.i 1eng,n 7es,n

,i+ 7e/ub,n 7u+,ng5

Pe*erikaan Fiik

P,1, /,ngg,l % M,+e/(*$) 8-u7ul $%5$4 "IB


5/20

• Ke,1,,n umum : B,i7

• Kes,1,+,n : !om-os men/is

• T,n1, ' /,n1, Vi/,l

o Te7,n,n 1,+,h : $(* < %* mmg

o N,1i : %) >


6/20

Ins-e7si : /i1,7 /,m-,7 -uls,si i?/us ?o+1is

P,l-,si : -uls,si i?/us ?o+1is 1,l,m b,/,s no+m,l

Pe+7usi : +e1u-# b,/,s ;,n/ung 1,l,m b,/,s no+m,l

Aus7ul/,si : bun6i ;,n/ung I


7/20

Pe*erikaan Pen)nan/

L,bo+,/o+ium (/,ngg,l % M,+e/ (*$)

5eni Pe*erikaan Hai Niai R))kan

Dara- r)tin

emoglobin !0.6 $(5* 3 $)5* g


8/20

&uli (*$)5 Usi, Keh,mil,n 8UK (23(4 minggu5 P,sien meme+i7s,7,n 7,n1ung,nn6,

7e bi1,n5 P,sien meng,7u -e+n,h mel,7u7,n -eme+i7s,,n USG $> 1i -oli7lini7

RSUD !i,.i 1eng,n h,sil ,i+ 7e/ub,n 7u+,ng5

D,+i -eme+i7s,,n Cisi7# -,sien /,m-,7 b,i7 < ?om-os men/is5 T,n1, ' /,n1,

0i/,l : Te7,n,n 1,+,h $(* < %* mmg# N,1i %) >


9/20

o Obse+0,si KU#TTV# IS# D&&

o De>,me/,sone ( > 4 mg i0

o !eC/+i,>one $ > ( g+ i0

o RL /e/es ?e-,/ l,n;u/ RL * /-m

Follow up

816190! #16190!

S Kelu,+ ,i+3,i+ 8# ge+,7,n ;,nin ,7/iC Kelu,+ ,i+3,i+ 8# ge+,7,n ;,nin ,7/iC

O KUTD : $(*


10/20

O KUTD : $$*

Tho+,> : ?o+< meni/# is 83

Geni/,l : 0,me/,sone (> ) mg

!eC/+i,>one $> (g

Obse+0,si KU TTVMeng,n;u+7,n ibu un/u7 be1 +es/

Meng,n;u+7,n ibu un/u7 men;,g, h6giene

Pembe+i,n 1e>, su1,h leng7,-

Meng,n;u+7,n ibu un/u7 be1 +es/

Meng,n;u+7,n ibu men;,g, h6giene

Boleh -ul,ngAn/ibio/i7 1ig,n/i 1eng,n ,n/ibio/i? o+,l 8 ?eC,1+o>il

Pr2/n2i

'b) 5anin

Ad 3ita* Dubi, ,1 bon,m Dubi,

Ad F)n/i2na* Dubi, ,1 bon,m Bon,m

Ad Sanati2na* Dubi, ,1 1ubi, Bon,m

ANAL'S'S KASUS

Ket)ban Pe:a- Dini (KPD$ Preter*

7e2ri Ka)

KPD P+e/e+m ,1,l,h -e?,hn6, sel,-u/

7e/ub,n se?,+, s-on/,n sebelum -e+s,lin,n

1,n sebelum = minggu

P,sien 1eng,n G$P*A* g+,0i1 (23(4 minggu

1eng,n +i.,6,/ 7elu,+ ,i+3,i+


11/20

Fakt2r Riik2

• Ku+,ngn6, ,s,m ,s7o+bi7 seb,g,i

7om-onen 7ol,gen

•

A1,n6, inCe7si

• Sosi,l e7onomi +en1,h

• In1e7s m,ss, /ubuh $9#% 8+en1,h

• Ke7u+,ng,n gii

• Me+o7o7

• Ri.,6,/ KPD -+e/e+m sebelumn6,

• Keb,n6,7,n 7,sus /e+;,1i /,n-, C,7/o+

+ei7o

P,sien /i1,7 me+o7o7# /i1,7 -,1, so?i,l

e7onomi +en1,h 1,n /i1,7 memili7i +i.,6,/

KPD P+e/e+m sebelumn6,

IMT -,sien $9#* 8+en1,h bis, men;,1i C,7/o+

+esi7o

KPD P+e/e+m -,1, -,sien ini 1,-,/ /e+;,1i

7,+en, IMT 6,ng +en1,h ,/,u /,n-, C,7/o+

+esi7o5

Keadian KPD

• %3$* 1,+i semu, 7eh,mil,n

• 94 -,1, 7eh,mil,n ?u7u- bul,n

P,1, 7eh,mil,n -+e/e+m→2 semu,

7el,hi+,n -+em,/u+e5

Ana*nei- A1,n6, +embes,n ?,i+,n 0,gin,

- Kelu,+ ?,i+,n b,n6,7


12/20

Dia/n2i

Se?,+, 7linis# 1i,gnos, KPD P+e/e+m

1i/eg,77,n bil, seo+,ng ibu h,mil meng,l,mi

-e?,hn6, se?,+, s-on/,n sebelum -e+s,lin,n

1,n sebelum = minggu

'npeki

- +embesn6, ?,i+,n 1,+i 0,gin,

- ;i7, 7e/ub,n b,+u -e?,h 1,n ;uml,h ,i+

7e/ub,n m,sih b,n6,7# -eme+i7s,,n ini

,7,n lebih ;el,s5

'npek)2

- 7elu,+ ?,i+,n 1,+i o+iCisium u/e+i e7s/e+num

8OUE

- bil, belum 7elu,+# Cun1us u/e+i 1i/e7,n#

-en1e+i/, 1imin/, b,/u7 8m,nu0e+

0,ls,0,/,m-,7 7elu,+ ?,i+,n 1,+i OUE

1,n /e+7um-ul -,1, Co+ni7s ,n/e+io+5

P,sien mengeluh7,n 7elu,+ ,i+3,i+ -,1, se;,7

usi, 7eh,mil,n (2 minggu

P,1, ins-e7si /e+1,-,/ +embes,n ?,i+,n

bening /i1,7 be+b,u 1,+i 0,gin,# se1i7i/

,sil ins-e7ulo /e+lih,/ 7elu,+ ?,i+,n 1,+i

o+iCisium u/e+i e7s/e+num

Pe*erikaan pen)nan/

!.Lab2rat2ri)*

- Tes L,7mus 8/es Ni/+,in: l,7mus

me+,h bi+u: ,1,n6, ,i+ 7e/ub,n

8,l7,lis5 - ,i+ 7e/ub,n =3=54

- Mi7+os7o-i7 8/es -,7ismene/es7,n

,i+ 7e/ub,n -,1, gel,s ob;e7 1,n

1ibi,+7,n 7e+ing5 g,mb,+,n 1,un

-,7is

9. USG# h,siln6,:

- Oligohi1+,mnion ,/,u ,nhi1+,mnion5

- Sel,in i/u# 1inil,i ,mnio/i? Clui1 in1e>#

-+esen/,si ;,nin# be+,/ ;,nin# usi, ;,nin5

Pe*erikaan pen)nan/

- Tes L,7mus 8/es Ni/+,in:

l,7mus me+,h bi+u: ,1,n6, ,i+

7e/ub,n5

- USG : oligohi1+,mnion


13/20

Penataakanaan KPD pada ke-a*ian 94;

6! *in//)

- An/ibio/i7 -+oCil,7sis5

- Ko+/i7os/e+oi1

- Pen,/,l,7s,n,,n 7eh,mil,n e7s-e7/,nsi

P,1, -,sien ini 1ibe+i7,n :

!eC/+i,>one $>(g

De>,me/,sone ( > ) g+ un/u7 -em,/,ng,n

-,+u

Sel,m, h,+i

P,sien 1i;,1.,l7,n un/u7 ?on/+ol 7e

-oli7lini7 /,ngg,l $= M,+e/ (*$)

Kei*p)an

P,1, -,sien .,ni/, ($ /,hun# G$P*A* g+,0i1 (23(4 minggu 1eng,n KPD -+e/e+m#

-en,/,l,7s,n,,n 6,ng 1ibe+i7,n su1,h sesu,i 1eng,n /eo+i# 1im,n, 1ibe+i7,n ,n/ibio/i7

-+oCil,7sis 1,n 7o+/i7os/e+oi1 sel,m, h,+u un/u7 -em,/,ng,n -,+u# se+/, ,n;u+,n 7e-,1, ibu

un/u7 be1+es/ 1,n men;,g, h6giene un/u7 menu+un7,n +esi7o inCe7si5


14/20

P%&BAHASAN

D%F'N'S'

Ke/ub,n -e?,h 1ini 8KPD ,1,l,h -e?,hn6, sel,-u/ 7e/ub,n se?,+, s-on/,n 6,ng/i1,7 1ii7u/i 1eng,n /,n1,3/,n1, in-,+/u ,/,u sel,-u/ 7e/ub,n -e?,h $ ;,m 7emu1i,n /i1,7

1ii7u/i /,n1,3/,n1, ,.,l -e+s,lin,n /,n-, melih,/ umu+ 7eh,mil,n5 &i7, -e?,hn6, 7e/ub,n

sebelum usi, 7eh,mil,n = minggu 8-+e/e+m 1isebu/ seb,g,i KPD -+e/e+m 8-+e/e+m

-+em,/u+e +u-/u+e oC memb+,ne < PPROM 5 P,1, -,sien ini# ibu meng,/,7,n 7elu,+n6, ,i+

6,ng me+u-,7,n ,i+ 7e/ub,n 6,ng menun;u77,n -e?,hn6, sel,-u/ 7e/ub,n 6,ng /,n-, 1ii7u/i

/,n1,3/,n1, -e+s,lin,n 1eng,n /i1,7 ,1,n6, his 1,n -engelu,+,n len1i+ 1,+,h 6,ng

me+u-,7,n /,n1,3/,n1, ,.,l -e+s,lin,n5

ANGKA K%5AD'AN

Insi1en 7e/ub,n -e?,h ini 1il,-o+7,n be+0,+i,si 1,+i ) hingg, $* # 1im,n, se7i/,+

(* 7,sus /e+;,1i sebelum mem,su7i m,s, ges/,si = minggu5 Se7i/,+ % hingg, $* -,sien

7e/ub,n -e?,h 1ini memili7i +isi7o /inggi inCe7si in/+,u/e+ine ,7ib,/ in/e+0,l ,n/,+, 7e/ub,n

-e?,h 1,n -e+s,lin,n 6,ng mem,n;,ng5 Ke/ub,n -e?,h 1ini be+hubung,n 1eng,n * hingg,

2* -e+s,lin,n -+e/e+m 1im,n, se7i/,+ =4 -,sien ,7,n meng,l,mi -e+s,lin,n s,/u minggu

lebih 1ini 1,+i ;,1.,l5

%7'OLOG'

",l,u-un b,n6,7 -ubli7,si /en/,ng KPD# n,mun -en6eb,bn6, m,sih belum

1i7e/,hui 1,n /i1,7 1,-,/ 1i/en/u7,n se?,+, -,s/i5 Bebe+,-, l,-o+,n men6ebu/7,n C,7/o+3

C,7/o+ 6,ng be+hubung,n e+,/ 1eng,n KPD# n,mun C,7/o+3C,7/o+ m,n, 6,ng lebih be+-e+,n

suli/ 1i7e/,hui5 Kemung7in,n 6,ng men;,1i C,7/o+ -+e1is-osisi ,1,l,h :

• InCe7si

InCe7si 6,ng /e+;,1i se?,+, l,ngsung -,1, sel,-u/ 7e/ub,n 87o+io,mnioni/is m,u-un

,sen1e+en 1,+i 0,gin, ,/,u inCe7si -,1, ?,i+,n 7e/ub,n bis, men6eb,b7,n /e+;,1in6,

KPD se-e+/i inCe7si 7l,mi1i,5 Ge;,l, 7lini7 -,1, 7o+io,mnioni/is ,n/,+, l,in ibu

men1e+i/, -,n,s# u/e+us 6,ng /eg,ng# ?,i+,n 0,gin, 6,ng be+b,u# -ening7,/,n 1en6u/

;,n/ung ;,nin# leu7osi/osis


15/20

• Se+0i7 6,ng in7om-e/ensi,# 7,n,lis se0i7,lis 6,ng sel,lu /e+bu7, oleh 7,+en, 7el,in,n -,1,

se+0i7 u/e+i 8,7ib,/ -e+s,lin,n# ?u+e/,ge5 P,1, se0i7s in7om-e/ensi, 1eng,n se+0i7 /i-is ,/,u

7u+,ng 1,+i 9 mm memili7i +esi7o se7i/,+ (4 /e+;,1in6, KPD

• Te7,n,n in/+, u/e+in 6,ng meninggi ,/,u mening7,/ se?,+, be+lebih,n 8o0e+1is/ensi u/e+us

mis,ln6, /+,um,# hi1+,mnion# gemelli 84*# 7emb,+ /ig, 89*5 T+,um, oleh bebe+,-, ,hli

1ise-,7,/i seb,g,i C,7/o+ -+e1isisi ,/,u -en6eb,b /e+;,1in6, KPD5 T+,um, 6,ng 1i1,-,/

mis,ln6, hubung,n se7su,l# -eme+i7s,,n 1,l,m# m,u-un ,mnosin/esis men6eb,b,7,n

/e+;,1in6, KPD 7,+en, bi,s,n6, 1ise+/,i inCe7si

• Kel,in,n le/,7 mis,ln6, sungs,ng# sehingg, /i1,7 ,1, b,gi,n /e+en1,h 6,ng menu/u-i -in/u

,/,s -,nggul 8PAP 6,ng 1,-,/ mengh,l,ngi /e7,n,n /e+h,1,- memb+,n b,gi,n b,.,h

• Ri.,6,/ -e+s,lin,n -+e/e+m sebelumn6, : +isi7o (32>

• K,1,+ !R 8 ?o+/i?o/+o-oin +ele,sing ho+mone m,/e+n,l /inggi mis,ln6, -,1, s/+ess

-si7ologis#1sb5 D,-,/ men;,1i s/imul,si -e+s,lin,n -+e/e+m

PA7OF'S'OLOG'

B,n6,7 /eo+i# mul,i 1,+i 1eCe7 7+omosom# 7el,in,n 7ol,gen# s,m-,i inCe7si5

P,1, seb,gi,n bes,+ 7,sus /e+n6,/, be+hubung,n 1eng,n inCe7si 8s,m-,i )45

igh 0i+ulen?e : b,?/e+oi1es5 Lo. 0i+ulen?e : l,?/ob,?illus5

Kol,gen /e+1,-,/ -,1, l,-is,n 7om-,7/, ,mnion# Cib+obl,s# ;,+ing,n +e/i7ule+ 7o+ion 1,n

/+oCobl,s5 Sin/esis m,u-un 1eg+,1,si ;,+ing,n 7ol,gen 1i7on/+ol oleh sis/em ,7/iCi/,s 1,n

inhibisi in/e+leu7in3$ 8IL3$ 1,n -+os/,gl,n1in5 &i7, ,1, inCe7si 1,n inCl,m,si# /e+;,1i

-ening7,/,n ,7/iCi/,s IL3$ 1,n -+os/,gl,n1in# mengh,sil7,n 7ol,gen,se ;,+ing,n# sehingg,

/e+;,1i 1e-olime+is,si 7ol,gen -,1, sel,-u/ 7o+ioni1,/ion 1,n ,7/i0i/,s -+o/eoli/i7 1,-,/ /e+lih,/ 1,l,m e+i/+osi/5 B,6i


16/20

-+em,/u+e memili7i -e+/,h,n,n ,n/io7si1,n 6,ng lem,h5 Re,7si +,1i7,l beb,s -,1, b,6i

-+em,/u+e menun;u7,n /ing7,/ li-i1 -+eo>i1,/ion 6,ng lebih /inggi sel,m, minggu -e+/,m,

7ehi1u-,n5 Bebe+,-, 7om-li7,si -,1, neon,/us 1i-e+7i+,7,n /e+;,1i ,7ib,/ mening7,/n6,

7e+en/,n,n neon,/us /e+h,1,- /+,um, +,1i7,l o7sigen 8Anonim# (**)5

D'AGNOS'S

Di,gnosis h,+us 1i1,s,+7,n -,1, :

An,mnesis 1eng,n +i.,6,/ 7,-,n 7elu,+ ,i+# .,+n,# b,u

Ins-e7si 1eng,n melih,/ 7elu,+n6, ?,i+,n -e+0,gin,m

Ins-e7ulo

Bil, Cun1us 1i/e7,n ,/,u b,gi,n /e+en1,h 1igo6,ng7,n 7elu,+ ?,i+,n 1,+i OUE 1,n/e+7um-ul 1i Co+ni7s -os/e+io+5

Peme+i7s,,n 1,l,m 1i/emu7,n ,1,n6, ?,i+,n 1,l,m 0,gin, 1,n sel,-u/ 7e/ub,n /i1,7

,1,5

Peme+i7s,,n l,bo+,/o+ium 1eng,n 7e+/,s l,7mus menun;u77,n +e,7si b,s, 8l,7mus

me+,h be+ub,h men;,1i bi+u 8Kumbo6o 177# (**$5

Tes -,7is# 1eng,n mene/es7,n ?,i+,n 7e/ub,n -,1, gel,s ob;e7 1,n 1ibi,+7,n 7e+ing5

Peme+i7s,,n mi7+os7o-i7 menun;u77,n 7+is/,l ?,i+,n ,mnion 1,n g,mb,+,n 1,un -,7is 8P+,.ih,+1;o 177# (**(5

Peme+i7s,,n ul/+,sonog+,Ci 8USG -eme+i7s,,n ini 1im,7su17,n un/u7 melih,/

;uml,h ?,i+,n 7e/ub,n 1,l,m 7,0um u/e+i5 P,1, 7,sus KPD /e+lih,/ ;uml,h ?,i+,n

7e/ub,n 6,ng se1i7i/5 N,mun se+ing /e+;,1i 7es,l,h,n -,1, -en1e+i/,

oligohi1+omnion5

",l,u-un -en1e7,/,n 1i,gnosis KPD ?u7u- b,n6,7 m,?,m 1,n ?,+,n6,# n,mun -,1,

umumn6, KPD su1,h bis, /e+1i,gnosis 1eng,n ,n,mnes, 1,n -eme+i7s,,n se1eh,n,

KO&PL'KAS'

• InCe7si in/+,u/e+ine 87o+io,mnioni/is ,s?en1ens 1,+i 0,gin, 7e in/+,u/e+in5 P,1, ibu

7e+en/,n,n /e+h,1,- inCe7si s,ng,/ /inggi 1ilh,/ 1,+i ge;,l, 7lini7 -,n,s# u/e+us

/eg,ng# leu7osi/osis5

• P+ol,-s /,li -us,/# bis, s,m-,i g,.,/ ;,nin 1,n 7em,/i,n ;,nin ,7ib,/ hi-o7si, 8se+ing

/e+;,1i -,1, -+esen/,si bo7ong ,/,u le/,7 lin/,ng5

• P+em,/u+i/,s# -e+s,lin,n -+e/e+m# ;i7, /e+;,1i -,1, usi, 7eh,mil,n -+e/e+m5


17/20

• Dis/osi, 8-,+/us 7e+ing se+ing 7,+en, oligohi1+,mnion ,/,u ,i+ 7e/ub,n h,bis5

P,1, -,sien ini /i1,7 1i/emu7,n ,1,n6, 7om-li7,si -,1, ibu 1,n< ,/,u ;,nin5

P%NA7ALAKSANAANPen,/,l,7s,n,,n 7eh,mil,n 1eng,n 7om-li7,si 7e/ub,n -e?,h 1ini -e+lu mem-e+/imb,ng7,n

mo+bi1i/,s 1,n mo+/,li/,s imm,/u+i/,s neon,/,l 6,ng be+hubung,n 1eng,n -e+s,lin,n 1,n

+isi7o inCe7si /e+h,1,- ibu 1,n ;,nin5

&edikai

• K2rtik2ter2id.

Pembe+i,n 7o+/i7os/e+oi1 1,-,/ mene7,n mo+bi1i/,s 1,n mo+/,li/,s -e+in,/,l -,s?,7e/ub,n -e?,h 1ini -+e/e+m5 Ko+/i7os/e+oi1 ;ug, mene7,n +isi7o /e+;,1in6, sin1+om

1is/+ess -e+n,C,s,n 8(* ' 4#2# hemo+,ghi in/+,0en/+i7ul,+ 8=#4 ' $4#9# en/e+o7oli/is

ne7+o/i7,ns 8*#% ' 2#)5 Re7omen1,si seb,gi,n bes,+ menggun,7,n be/,me/h,son

8?eles/one in/+,mus?ul,+ $( mg se/i,- (2 ;,m sel,m, ( h,+i5 N,/ion,l Ins/i/u/e oC

e,l/h me+e7omen1,si7,n -embe+i,n 7o+/i7os/e+oi1 sebelum m,s, ges/,si *3

minggu# 1eng,n ,sumsi 0i,bili/,s Ce/us 1,n /i1,7 ,1, inCe7si in/+, ,mnio/i75 Pembe+i,n

7o+/i7os/e+oi1 se/el,h m,s, ges/,si 2 minggu m,sih ?on/+o0e+si,l 1,n /i1,7

1i+e7omen1,si7,n 7e?u,li ,1, bu7/i imm,/u+i/,s -,+u mel,lui -eme+i7s,,n

,mniosen/esis5

• Antibi2tik

Pembe+i,n ,n/ibio/i? -,1, -,sien 7e/ub,n -e?,h 1ini 1,-,/ mene7,n inCe7si neon,/,l 1,n

mem-e+-,n;,ng -e+io1e l,/ensi5 Se;uml,h ,n/ibio/i7 6,ng 1igun,7,n meli-u/i ,m-isilin

$ g+,m 1eng,n 7ombin,si e+i/+omisin (4* mg se/i,- ) ;,m sel,m, 2% ;,m# 1ii7u/i

-embe+i,n ,mo7sisilin (4* mg 1,n e+i/+omisin ** mg se/i,- % ;,m un/u7 lim, h,+i5

P,sien 6,ng men1,-,/ 7ombin,si ini 1imung7in7,n 1,-,/ mem-e+/,h,n7n, 7,n1ung,n

sel,m, minggu se/el,h -enghen/i,n -embe+i,n ,n/ibio/i7 se/el,h = h,+i5

• A/en 72k2itik

Pembe+i,n ,gen/ /o7oli/i7 1ih,+,-7,n 1,-,/ mem-e+-,n;,ng -e+io1e l,/ensi n,mun /i1,7

mem-e+b,i7i lu,+,n neon,/,l5 Ti1,7 b,n6,7 1,/, 6,ng /e+se1i, mengen,i -em,7,i,n


18/20

,gen /o7oli/i7 un/u7 7e/ub,n -e?,h 1ini5 Pembe+i,n ,gen /o7oli/i7 ;,ng7, -,n;,ng /i1,7

1i-e+7en,n7,n 1,n hingg, 7ini m,sih menunggu h,sil -eneli/i,n lebih ;,uh5

!. Penataakanaan berdaarkan *aa /etai

• M,s, ges/,si 1ib,.,h (2 minggu5

Seb,gi,n bes,+ -,sien ,7,n meng,l,mi -e+s,lin,n 1,l,m $ minggu bil, /e+;,1i 7e/ub,n

-e?,h 1ini 1eng,n -e+io1e l,/ensi se7i/,+ ) h,+i # 1,n seb,gi,n bes,+ 6,ng l,hi+ bi,s,n6,

meng,l,mi b,n6,7 m,s,l,h se-e+/i -en6,7i/ -,+u 7+oni7# g,nggu,n neu+olog6 1,n

-e+7emb,ng,n# hi1+oseC,lus 1,n ?e+eb+,l -,ls65 Se7i/,+ 4* ;,nin 1eng,n 7e/ub,n -e?,h

1ini -,1, minggu 7e $9 ,7,n meng,l,mi sin1+om Po//e+# (4 -,1, me+e7, 6,ng l,hi+ 1i

minggu 7e (( 1,n $* -,1, me+e7, 6,ng l,hi+ se/el,h m,s, ges/,si () mingu5 P,sien

h,+us men1,-,/ 7onseling mengen,i m,nC,,/ 1,n +isi7o -en,/,l,7s,n,,n ,7,n

7emung7in,n b,6i /i1,7 1,-,/ be+/,h,n se?,+, no+m,l5

• M,s, ges/,si (2 ' $ minggu

Pe+s,lin,n sebelum m,s, ges/,si ( memi?u mo+bi1i/,s 1,n mo+/,li/,s neon,/,l be+,/5

Bil, /i1,7 1i;um-,i inCe7si in/+,,mnio/i7 m,7, 7eh,mil,n 1iu-,6,7,n 1i-e+/,h,n7,n

hingg, 2 minggu5 Bil, ,1, inCe7si in/+,,mnio/i7 m,7, -,sien ,7,n mel,hi+7,n 1,l,m

.,7/u $ minggu5 Klinisi h,+us membe+i7,n 7o+/i7os/e+oi1 1,n ,n/ibio/i7 se+/,

mel,7u7,n -enil,i,n men6elu+uh mengen,i 7e,1,,n ;,nin mel,lui moni/o+ing Ce/,l 1,n

ul/+,sonog+,Ci5

• M,s, ges/,si ( ' minggu

Bi,s,n6, Meng,l,mi m,s,l,h 1eng,n m,/u+i/,s -,+u3-,+u# in1u7si -e+s,lin,n 1,n

-en,ng,n,n b,6i -+em,/u+e h,+us sege+, 1i+en?,n,7,n5 U-,6, mem-e+/,h,n7,n

7eh,mil,n lebih l,m, se/el,h m,/u+i/,s -,+u ,7,n mening7,/7,n +isi7o ,mnioni/is

m,/e+n,l# 7om-+esi umbili?,l ?o+1# +,.,/ in,- 6,ng m,7in l,m, 1,n inCe7si neon,/,l5

• M,s, ges/,si 2 ' ) minggu

Bi,s,n6, 7linisi menghin1,+i u-,6, mem-e+l,m, 7eh,mil,n5 Sebu,h s/u1i menun;u7,n

b,h., -en,/,l,7s,n,,n 7onse+0,/iC ,n/,+, m,s, ges/,si 2 hingg, ) minggu ,7,n

mening7,/7,n +isi7o 7o+io,mni/i/is5 ",l,u-un 7o+/i7os/e+oi1 /i1,7 1iin1i7,si7,n un/u7

7eh,mil,n le.,/ 2 minggu# -embe+i,n ,n/ibio/i7 /e/,- 1il,7u7,n seb,g,i -+oCil,7sis


19/20

inCe7si s/+e-/o?o??us g+ou- B 1,n C,sili/,si -en,ng,n,n neon,/us -e+em,/u+ h,+us

1isi,-7,n sege+,5 Ke/ub,n -e?,h 1ini -+e/e+m ,/,u -e+/e+m PROM bu7,n me+u-,7,n

7on/+,in1i7,si -e+s,lin,n -e+0,gin,m 8Me1in, ill# (**)5

• Keh,mil,n A/e+m

Dibe+i7,n ,n/ibio/i7, ,m-i?ilin in;e7si $ g+,m

Obse+0,si suhu +e?/,l /i,- ;,m# bil, mening7,/ =#)*! sege+, /e+min,si

Bil, suhu +e?/,l /i1,7 mening7,/ 1i/unggu $( ;,m# bil, belum ,1, /,n1,3/,n1,

in-,+/u 1il,7u7,n /e+min,si5

• KPD 1eng,n 7eh,mil,n -+e/e+m be+1,s,+7,n -e+7i+,,n be+,/ ;,nin

Pe+7i+,,n be+,/ b,1,n ;,nin $4** g+

Dibe+i7,n ,n/ibio/i7, ,m-i?ilin $ g+ IV sel,m, ( ;,m sel,n;u/n6, ,mo7sisilin

>4** mg sel,m, h,+i

Dibe+i7,n 7o+/i7os/e+oi1 un/u7 me+,ngs,ng m,/u+,si -,+u 6,i/u 1e>,me/,son

(>$9 mg IV sel,m, (2 ;,m ,/,u be/,me/,son $( mg

Obse+0,si (>(2 ;,m# bil, belum in-,+/u sege+, /e+min,si5

Obse+0,si suhu +e?/,l /i,- ;,m bil, 7e?en1e+ung,n mening7,/ =#)*!# sege+,

/e+min,si5

Pe+7i+,,n be+,/ b,1,n ;,nin $4** g+

Dibe+i7,n ,n/ibio/i7, ,m-i?ilin $ g+ IV sel,m, ( ;,m sel,n;u/n6, ,mo7sisilin

>4** mg sel,m, h,+i

Obse+0,si (>(2 ;,m# bil, belum in-,+/u sege+, /e+min,si5

Obse+0,si suhu +e?/,l /i,- ;,m bil, 7e?en1e+ung,n mening7,/ =#)*!# sege+,

/e+min,si5

Bil, (>(2 ;,m ,i+ 7e/ub,n /i1,7 7elu,+ 1il,7u7,n USG

Bil, ;uml,h ,i+ 7e/ub,n ?u7u- 7eh,mil,n 1il,n;u/7,n 87onse+0,/iC

Bil, ;uml,h ,i+ 7e/ub,n se1i7i/# sege+, /e+min,si

Bil, (>(2 ;,m ,i+ 7e/ub,n m,sih /e/,- 7elu,+ sege+, /e+min,si5

Bil, 7onse+0,/iC sebelum -en1e+i/, -ul,ng 1ibe+i n,seh,/

Sege+, 7emb,li 7e RS bil, ,1, /,n1,3/,n1, 1em,m ,/,u 7elu,+ ,i+ 7e/ub,n

l,gi

Ti1,7 boleh 7oi/us


20/20

Ti1,7 boleh m,ni-ul,si 0,gin,5

DAF7AR PUS7AKA

$5 Alb,+ 5 Lu-us e+i/em,/osus sis/emi75 D,l,m: Noe+ MS# e1i/o+ 7e-,l,5 Ilmu -en6,7i/1,l,m5 E1isi 5 &,7,+/,: B,l,i Pene+bi/ FKUI $99)5 h: $4*395

(5 !unningh,m FG# Le0eno K Bloom SL# ,u/h &!# Rouse D S-ong !5 Obs/e/+i

"illi,ms5 (+1 e15 The M?G+,.3ill !om-,nies5 (*$*5

5 Rubin E# e1i/o+5 In: Essen/i,l -,/holog6: Lu-us e+i/em,/osus sis/emi75 /h e1i/ion5

Phil,1el-hi,: Li--i?o// "illi,ms "il7ins (**$5 -: %)3%#2)%39#)4*5

25 P+,.i+oh,+1;o# S5 Ilmu Kebi1,n,n5 &,7,+/,: ,6,s,n Bin, Pus/,7, S,+.ono

P+,.i+oh,+1;o(*$*5

45 Su1o6o A5"# Di,gnosis 1,n Pengelol,,n Lu-us E+i/em,/osus Sis/emi75 Pe+him-un,n

Reum,/ologi In1onesi, (*$$5

Case KPD Prematur-Febrina

Documents

Transcript of Case KPD Prematur-Febrina