Gawat Darurat Obgyn
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Transcript of Gawat Darurat Obgyn
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GAWAT DARURAT OBSGYN
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ANTERATUM1. Perdarahan 2. Abortus3. KET4. Mola Hidatidosa5. Solusio Plasenta6. Eklampsia / PE
INTRAPARTUM1. Tali Pusat
Menumbung2. Ruptur Uteri3. Distosia Bahu
POST PARTUM1. Atonia Uteri2. Laserasi Jalan
Lahir3. Retensi Plasenta4. Eklampsia5. Infeksi Puerperalis
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TD > 140/90
Usia < 20 minggu
Usia > 20 minggu
Protein Urine
Protein Urine
- -++
HipertensiKronis
Super imposed
PE
EKLAMSI
Ringan
Berat
Hipertensi Gestasional12 minggu normal lagi
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• PE RinganTD = 140/90Prot +1
• PE BeratTD = 160/100 (diastol >110)Prot > +2
• IMPENDING EKLAMPSIAPE Berat + 6x subjektif (cephagi hebat, nyeri ulu hati, kabur)
• EKLAMPSIAPE Berat + Kejang
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Penatalaksanaan Impending Eklampsia1. 10 cc MgSo4 40 % 5 cc boka
5 cc boki
2. Infus RL 500 ml + 25 cc MgSo4 40%
20-30 tetes/menit
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Penatalaksanaan Impending Eklampsia3. Nifedipin T<180 : ½ tab oral
T>180 : 1 tab Tensi tiap 30 menit
TD tetap TD Ulang nifedipin Nifedipin
dihentikan Sampai TD
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Penatalaksanaan EklampsiaJika disertai dengan kejang Terapi = Impending Eklampsia
obat anti hipertensi Clonidin IV
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Pendarahan Pada Kehamilan dan Persalinan
•Perdarahan Trisemester I Trisemester III Abortus ◊ Solplas KET ◊ PP Molahidatidosa
• Perdarahan Pasca Persalinan Atonia Uteri Luka / robek jalan lahir Sisa plasenta Retensio plasenta
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Penatalaksanaan Atonia UteriMasase fundus
uteri
Uterus kontraksi?
• Rujuk• Infus + oksitosin + tampon 40 tetes/menit, maks. 3 labu• Ergometrin 0,2 i.m tiap 15 menit maks. 1 mg
• Pengawasan kala IV
• Evakuasi bekuan darah/selaput ketuban• Kompresi Bimanual Interna (KBI)
•Pertahankan KBI, 1-2 menit•Keluarkan tangan hati-hati•Pengawasan kala IV
Evaluasi rutin
•Ulangi KBI •Metil ergometrin 0,2 mg i.m•Pasang infus NaCl + 10 iu oksitosin 50 tetes/menit
Uterus kontraksi?
Uterus kontraksi?
Ya
Ya
Ya
Tidak
Tidak
Tidak